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Ventricular Lead (ventricular + lead)
Selected AbstractsRight Ventricular Perforation due to Migration of a Ventricular LeadJOURNAL OF CARDIAC SURGERY, Issue 3 2010Fabien Doguet M.D. (J Card Surg 2010;25:303) [source] Addition of a Left Ventricular Lead to Conventional Pacing Systems in Patients with Congestive Heart Failure: Feasibility, Safety, and Early Results in 60 Consecutive PatientsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002CINDY M. BAKER BAKER, C.M., et al.: Addition of a Left Ventricular Lead to Conventional Pacing Systems in Patients with Congestive Heart Failure: Feasibility, Safety, and Early Results in 60 Consecutive Patients. Left bundle branch block worsens congestive heart failure (CHF) in patients with LV dysfunction. Asynchronous LV activation produced by RV apical pacing leads to paradoxical septal motion and inefficient ventricular contraction. Recent studies show improvement in LV function and patient symptoms with biventricular pacing in patients with CHF. The aim of this study was to determine the feasibility, safety, acute efficacy, and early effect on symptoms of the upgrade of a chronically implanted RV pacing system to a biventricular system. Sixty patients with NYHA Class III and IV underwent the upgrade procedure using commercially available leads and adapters. The procedure succeeded in 54 (90%) of 60 patients. Acute LV stimulation thresholds obtained from leads placed along the lateral LV wall via the coronary sinus compare favorably to those reported in current biventricular pacing trials. The complication rate was low (5/60, 8.3%): lead dislodgement (n = 1), pocket hematoma (n = 1), and wound infections (n = 3). During 18 months of follow-up (16.7%) of 60 patients died. Two patients that died failed the initial upgrade attempt. At 3-month follow-up, quality of life scores improved 31 ± 28 points (n = 29), P < 0.0001). NYHA Class improved from 3.4 ± 0.5 to 2.4 ± 0.7 (P = < 0.0001) and ejection fraction increased from 0.23 ± 0.8 to 0.29 ± 0.11 (P = 0.0003). Modification of RV pacing to a biventricular system using commercially available leads and adapters can be performed effectively and safely. The early results of this study suggest patients may benefit from this procedure with improved functional status and quality of life. [source] Coronary Sinus Left Ventricular Leads: Endocardial or Epicardial?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2010JOHN D. FISHER M.D. No abstract is available for this article. [source] Fatal Inappropriate ICD ShockJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007CHRISTIAN VELTMANN M.D. Introduction: Inappropriate implantable cardioverter defibrillator (ICD) therapy carries a low but relevant risk of ventricular proarrhythmia. In the present case, the extremely rare event of a fatal arrhythmia caused by inappropriate therapy is reported. Dislodgement of the ventricular lead to the level of the tricuspid annulus led to additional sensing of the atrial signal during sinus tachycardia. Spuriously, ventricular fibrillation was sensed and induced inappropriate ICD shocks. The fourth inappropriate shock caused ventricular fibrillation, which was subsequently undersensed by the dislodged lead due to low ventricular amplitudes. The ICD started antibradycardic pacing during ventricular fibrillation. After initial successful resuscitation, the patient died 1 week later due to severe hypoxic brain damage. Although not preventable in the present case, it underlines the necessity of immediate interrogation of the ICD after ICD therapy and deactivation of the ICD in the setting of a dislodged endocardial lead and intensive care monitoring of the patient until revision. [source] New Approach to Biphasic Waveforms for Internal Defibrillation:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2000Fully Discharging Capacitors Internal Defibrillation with Fully Discharging Capacitors. Introduction: The use of two independent, fully discharging capacitors for each phase of a biphasic defibrillation waveform may lead to the design of a simpler, smaller, internal defibrillator. The goal of this study was to determine the optimal combination of capacitor sizes for such a waveform. Methods and Results: Eight full-discharge (95/95% tilt), biphasic waveforms produced by several combinations of phase-1 capacitors (30, 60, and 90 ,F) and phase-2 capacitors (1/3, 2/3, and 1.0 times the phase-1 capacitor) were tested and compared to a single-capacitor waveform (120 ,F, 65/65% tilt) in a pig ventricular fibrillation model (n = 12, 23 ± 2 kg). In the full-discharge waveforms, phase-2 peak voltage was equal to phase-1 peak voltage. Shocks were delivered between a right ventricular lead and a left pectoral can electrode. E50s and V50s were determined using a ten-step Bayesian process. Full-discharge waveforms with phase-2 capacitors of ,40 ,F had the same E50 (6.7 ± 1.7 J to 7.3 ± 3.9 J) as the single-capacitor truncated waveform (7.3 ± 3.7 J), whereas waveforms with phase-2 capacitors of ,60 ,F had an extremely high E50 (14.5 ± 10.8 J or greater, P < 0.05). Moreover, of the former set of energy-efficient waveforms, those with phase-1 capacitors of ,60 ,F additionally exhibited V50s that were equivalent to the V50 of the single-capacitor waveform (344 ± 65 V to 407 ± 50 V vs 339 ± 83 V). Conclusion: Defibrillation efficacy can be maintained in a full-discharge, two-capacitor waveform with the proper choice of capacitors. [source] Coronary Vein Angioplasty with Noncompliant Balloon for Resistant Coronary Vein Stenosis During Left Ventricular Lead ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2008KETUL CHAUHAN M.D. This report describes a patient who underwent cardiac resynchronization therapy (CRT) in the setting of a severe stenosis in the lateral coronary vein that prevented passage of a left ventricular lead. The stenosis was unresponsive to standard compliant balloon dilatation but was successfully treated with a noncompliant balloon. Venoplasty with noncompliant balloon should be considered for resistant coronary vein stenosis encountered during CRT device implantation. [source] Collateral Approach for Biventricular Pacing of Coronary Sinus Ostium ObstructionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2008YOSHIMITSU SOGA M.D. A 71-year-old man with dilated cardiomyopathy and complete atrioventricular block underwent cardiac resynchronization therapy (CRT) due to chronic heart failure that was not improved by conventional medical treatment. But we found the coronary vein ostium was completely obstructed by coronary venography. The contrast medium flowed out from the right atrium via a collateral pathway. Thus a left ventricular lead was placed via a collateral pathway and was successfully implanted without complications. The postoperative threshold was 2.7 V at 0.4 ms. The subjective symptom improved after CRT. The safety of this procedure was not clear. [source] Extraction of the Inner Coil of a Pacemaker Lead Slid into the Pulmonary ArteryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007F.E.S.C., PIER GIORGIO GOLZIO M.D. A patient required lead extraction for chronic draining sinus, due to abandoned leads. Preoperatively, the chest film showed a filament in the right pulmonary artery: it was the inner coil of an old atrial lead that, while remaining anchored to the auricle, slid outside the outer coil. By right subclavian approach, the old ventricular lead and the outer coil of the atrial lead were removed. Then, by right jugular approach, the freely floating end of theinner atrial coil was grasped by a pig-tail catheter, drawn back into the superior vena cava, exteriorized by a Lasso catheter, and finally extracted. [source] Importance of Anterograde Visualization of the Coronary Venous Network by Selective Left Coronary Angiography Prior To ResynchronizationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2007NICOLAS DELARCHE M.D. Background: Understanding of coronary anatomy is essential to the advancement of cardiac resynchronization therapy (CRT) techniques. We determined whether the difficulties associated with catheterization of the coronary sinus (CS) and its lateral branches could be overcome by a preliminary angiographical study of the coronary venous system carried out during a pre-operative coronary angiography with examination of venous return. Methods and Results: All patients were scheduled for an exploratory angiography procedure and indicated for CRT. Group A patients were implanted with a CRT device after a right arterial angiographical procedure while group B patients had a selective left angiogram including examination of venous return. Data analyzed in group B were: position of CS ostium, number and distribution of lateral branches, and ability to preselect a marginal vein suitable for catheterization. Subsequent device implantation was guided by these parameters. A total of 96 and 89 patients were included in groups A and B, respectively. Implantation success rates were not different (98% and 100%, respectively), but CS catheterization time was reduced in group B (6 minutes vs 4 minutes; P < 10,6) as well as total time required to position the left ventricular lead (25 minutes vs 15 minutes; P < 10,6), fluoroscopy exposure (7 minutes vs 5 minutes; P < 10,6), and volume of contrast medium required (45 mL vs 15 mL; P < 10,6). Conclusion: A coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient-specific preselection of appropriate tools for the procedure. [source] Successful Implantation of a Coronary Sinus Lead After Stenting of a Coronary Vein StenosisPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2003BERRY M. VAN GELDER Dislodgment of the coronary sinus lead was observed in a 79-year-old patient 8 months after implantation of a biventricular pacing system. A severe stenosis in the posterolateral branch, in which the lead was previously positioned, prohibited reinsertion of the lead. Because no other branches with adequate anatomy for lead insertion were available in the targeted area, the stenosis was dilated and stented. Subsequently, the left ventricular lead could be reimplanted in the same vessel. (PACE 2003; 26:1904,1906) [source] Inhibition of Biventricular Pacemakers by Oversensing of Far-Field Atrial DepolarizationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2002IGOR LIPCHENCA LIPCHENCA, I., et al.: Inhibition of Biventricular Pacemakers by Oversensing of Far-Field Atrial Depo-larization. This report describes two patients who exhibited far-field oversensing of the P wave by the ventricular channel of a DDD biventricular pacemaker implanted for the treatment of congestive heart failure. Oversensing probably occurred secondary to slight displacement of the left ventricular lead in the coronary venous system. Long-term reliable pacing was restored by decreasing the sensitivity of the ventricular channel. [source] Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve SurgeryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2002THORSTEN LEWALTER LEWALTER, T., et al.: Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve Surgery. Sustained monomorphic ventricular tachycardia (VT) after valve surgery represents a clinical entity with different tachycardia mechanisms. This case report describes an incessant VT after tricuspid and aortic valve replacement that did not respond to antiarrhythmic drug treatment. The tachycardia exhibited VA block and a right bundle branch block pattern with left-axis deviation, suggesting ventricular excitation via the left posterior fascicle. The electrophysiological study was limited by the prosthetic tricuspid and aortic valve replacement, therefore a transseptal approach was necessary to obtain access to the ventricular myocardium. Radiofrequency catheter ablation was performed in the proximal left bundle or distal His region with termination of the incessant VT followed by complete AV block. After pacemaker implantation using a transvenous right atrial and an epicardial ventricular lead, no VT reoccurrence could be documented. [source] Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal SystemPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2001ANTONIS S. MANOLIS MANOLIS, A.S., et al.: Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal System. A previous report described our preliminary experience with a highly successful pacing lead removal system (VascoExtor). Extending this experience, we found it necessary to use additional tools to enhance the success of percutaneous lead extraction with this system. In the present series, we used the standard locking stylets (S and K), and recently, one newer type of stylet (Magic) over the last 3 years in 34 patients to extract 48 pacemaker leads in 31 patients and 3 defibrillator (ICD) leads in 3 patients. Lead extraction was carried out in 23 men and 11 women (aged 64 ± 17 years) because of pacemaker infection (n = 21), pacemaker (n = 8) or ICD (n = 3) lead malfunction, or prior to ICD implant (n = 2). Leads were in place for 3.5 ± 3.7 years. Infections, involving pocket and lead(s), were due to S. epidermidis (n = 13), S. aureus (n = 6), S. aureus plus E. coli (n = 1), or fungi (n = 1). Of the 48 pacing leads, 31 were ventricular, 15 atrial, and 2 were VDD leads. The ICD leads were two double-coil leads (CPI) and one single-coil lead (Telectronics). Using the S (n = 12), K (n = 8), or Magic (n = 3) stylets, all pacing leads in 23 patients and the ICD leads in 2 patients were successfully removed from a subclavian approach using the locking stylets. However, in nine (26.5%) patients ancillary tools were required. In four patients, lead fragments were captured with use of a noose catheter, a pigtail catheter, and a bioptome from a right femoral approach. In two patients, locking could not be effected and a noose catheter from the right femoral vein was used, aided by a pigtail and an Amplatz catheter and a bioptome to remove three leads. In a patient with an ICD lead, a combined subclavian (stylet S) and right femoral approach (noose catheter) was required. In a patient with a dysfunctional ventricular lead 12 years old, a motor drive unit was used to facilitate the exchange of locking stylets, but extraction failed. In another patient, a fragment of a dysfunctional ventricular lead remained intravascularly despite resorting to a femoral approach. Finally, lead removal was completely (32/34, 94%) or partially (1/34, 3%) successful in 33 (97%) of 34 patients for 50 (98%) of 51 leads without complications. In conclusion, to enhance the success of pacing or ICD lead extraction with use of the VascoExtor locking stylets, an array of ancillary tools were required in more than one fourth of patients. [source] Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H. Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source] Compatibility of Automatic Threshold Tracking Pacemakers with Previously Implanted Pacing Leads in ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2002OSMAN KUCUKOSMANOGLU KUCUKOSMANOGLU, O., et al.: Compatibility of Automatic Threshold Tracking Pacemakers with Previously Implanted Pacing Leads in Children. The Autocapture function controls and optimizes the amplitude of the pacing pulse and saves energy. The manufacturer recommends using a special low polarization, low threshold bipolar Pacesetter lead for the Autocapture function. The purpose of this study was to evaluate the compatibility of Autocapture with previously implanted pacing leads. The study included 15 patients (mean age 13.6 ± 3.4 years) who needed pulse generator replacement and received the VVIR pacemaker Regency SR+ or the DDDR pacemakers Affinity DR or Integrity DR with the Autocapture function. The new pulse generators connected to previously implanted ventricular leads. At the time of implantation the pacing threshold was 1.0 ± 0.35 V at 0.5 ms, the lead impedance was 580 ± 80 ,, and the spontaneous R wave amplitude was 7.89 ± 4.89 mV. The polarization signal (PS) was 3.8 ± 3.04 mV, and evoked response (ER) was 8.15 ± 4.57 mV at the predischarge testing. Follow-up telemetry was done at months 1, 3, 6, 12, and 18. The follow-up duration was 9.4 ± 5 months (range 1,18 months). If the results of PS and ER measurements were acceptable for Autocapture, it turned on at the 1-month visit. In six (40%) patients the results were found acceptable for Autocapture function. Age, lead impedance, pacing threshold, intrinsic R wave measurement, lead age, fixation mechanism, and ER measurements were not statistically different in Autocapture suitable and not suitable groups. The main reason not to activate Autocapture had been increased PS. Any significant fluctuations were not observed in pacing threshold, lead impedance, ER, and PS during follow-up. In conclusion, previously implanted pacing leads may be compatible with the Autocapture function. [source] Optimization of Repolarization during Biventricular Pacing: A New Target in Patients with Biventricular Devices?ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Cengizhan Türko, lu M.D. Background: Evaluation of repolarization during sequentional biventricular pacing. Methods: Patients with biventricular devices, and left ventricular leads placed to the basal part of lateral left ventricular wall were enrolled. QRS, QTc, JTc, and corrected Tpeak-Tend intervals were compared during sequentional biventricular, left ventricular, and right ventricular pacing. Results: Five patients with nonischemic and five with ischemic cardiomyopathy due to anterior myocardial infarction were enrolled. No correlation was observed between values of repolarization among patients. The optimal values of repolarization were significantly different from values of echocardiographically guided hemodynamic optimization. Two patients with biventricular pacing-induced ventricular fibrillation were successfully treated by reprogramming of V-V delay according to interventricular delay resulting in shorter Tpeak-Tend interval, although delayed effect of amiodarone in one of these patients cannot be ruled out. Conclusions: Patients with biventricular devices may be prone to development of ventricular arrhythmias depending on programmed V-V interval. We suggest that optimization of repolarization may be performed in patients with biventricular pacemakers in the absence of backup ICD and those with frequent episodes of ventricular tachyarrhythmias, although this finding deserves further study. Ann Noninvasive Electrocardiol 2010;15(1):36,42 [source] | ||||||||||