Implantation of lumenless pacing leads at the inter-atrial septum and right ventricular outflow tract with deflectable catheter-sheath

Abstract

Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class I indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French (Fr) lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath (Medtronic Inc., USA) were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results (mean atrial pacing threshold: 0.87 V; mean P wave amplitude: 2.28 mV; mean ventricular pacing threshold: 0.53V; mean R wave amplitude: 8.75 mV) were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.

Keywords

selective site pacing / lumenless lead / inter-atrial septum / right ventricular outflow tract

References

[1] Food and Drug Administration New Device Approval. SelectSecure™ Lead Model 3830-P030036. http://www.fda.gov/cdrh/mda/docs/p030036.html (8 April, 2008, date last accessed).

[2] WilkoffB. L., CookJ. R., EpsteinA. E., et al.. Dual chamber and VVI implantable defibrillator trial investigators. dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and VVI implantable defibrillator (DAVID) trial. JAMA, 2002, 288: 3115-3123

[3] GammageM. D., LiebermanR. A., YeeR., et al.. Multi-center clinical experience with a lumenless, catheter-delivered, bipolar, permanent pacemaker lead: implant safety and electrical performance. Pacing Clin Electrophysiol, 2006, 29(8): 858-865

[4] LiebermanR., GrenzD., MondH. G., et al.. Selective site pacing: defining and reaching the selected site. Pacing Clin Electrophysiol, 2004, 27(6Pt2): 883-886

[5] PadelettiL., LiebermanR., ValsecchiS., et al.. Physiologic pacing: new modalities and pacing sites. Pacing Clin Electrophysiol, 2006, 29(Suppl2): S73-S77

[6] AlizadehA., MalekiM., BassiriH., et al.. Evaluation of atrial thrombus formation and atrial appendage function in patients with pacemaker by transesophageal echocardiography. Pacing Clin Electrophysiol, 2006, 29(11): 1251-1254

[7] TseH. F., HettrickD. A., MehraR., et al.. Improved atrial mechanical efficiency during alternate- and multiple-site atrial pacing compared with conventional right atrial appendage pacing: implications for selective site pacing to prevent atrial fibrillation. J Am Coll Cardiol, 2006, 47(1): 209-212

[8] PorcianiM. C., SabiniA., ColellaA., et al.. Interatrial septum pacing avoids the adverse effect of interatrial delay in biventricular pacing: an echo-Doppler evaluation. Europace, 2002, 4(3): 317-324

[9] ParekhS., SteinK. M.. Selective site pacing: rationale and practical application. Curr Cardiol Rep, 2008, 10(5): 351-359

[10] CaiL., HuangD. J., YanC. B., et al.. Report on initiating clinical research for electrical and mechanical synchronism of selective region pacing in the right ventricular. Zhonghua Xin Xue Guan Bing Za Zhi (Chinese), 2007, 35(2): 147-150

[11] Mc GaviganA. D., MondH. G.. Selective site ventricular pacing. Curr Opin Cardiol, 2006, 21(1): 7-14

[12] YeeR., KleinG. J., KrahnA. C., et al.. Selective site pacing: tools and training. Pacing Clin Electrophysiol, 2004, 27(6Pt2): 894-896

[13] FröhligG., SchwaabB., KindermannM.. Selective site pacing: the right ventricular approach. Pacing Clin Electrophysiol, 2004, 27(6Pt2): 855-861

[14] GammageM., MarshA.. Randomized trials for selective site pacing: do we know where we are going?. Pacing Clin Electrophysiol, 2004, 27(6Pt2): 878-882

[15] de CockC., MeyerA., KampO., et al.. Hemodynamic benefits of right ventricular outflow tract pacing: comparison with right ventricular apex pacing. Pacing Clin Electrophysiol, 1998, 21(3): 536-541

[16] LapageM., RheeE.. Alternative delivery of a 4Fr lumenless pacing lead in children. Pacing Clin Electrophysiol, 2008, 31(5): 543-547

[17] KarpawichP. P., WebsterP., GoodmanE., et al.. Repositioning a dislodged new lumenless pacing lead: a simple tool and technique. Pacing Clin Electrophysiol, 2008, 31(3): 354-357

[18] KennyD., WalshK. P.. Noncatheter-based delivery of a single-chamber lumenless pacing lead in small children. Pacing Clin Electrophysiol, 2007, 30(7): 834-838

[19] TuzcuV.. Implantation of SelectSecure leads in children. Pacing Clin Electrophysiol, 2007, 30(7): 831-833

[20] HanskyB., VogtJ., GueldnerH., et al.. Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases. Pacing Clin Electrophysiol, 2007, 30(1): 44-49