Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal p...Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.展开更多
Background Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy （CRT） devices, there are many hurdles related mainly to the variation in the anatomy of the coronar...Background Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy （CRT） devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very sharply-angulated or tortuous of the lateral or posterolateral cardiac vein.Methods Totally 44 patients, 28 males and 16 females, with congestive heart failure and intraventricular conduction delay were studied retrospectively. There were 23 patients who had left ventricular （LV） lead implantation using standard techniques and equipment. For the other 21 patients with LV lead implantation we used the Attain Select Ⅱ catheter delivery system. The patients were seen every 3-6 months for 12 months and the efficacy of the primary procedure, LV lead implantation time, procedure and fluoroscopy time and the complications associated with the two techniques were evaluated.Results There were no significant differences in the age, gender, New York Heart Association （NYHA） functional class,ischemic etiology, QRS duration, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and LV dyssynchrony between the two groups. The LV lead implantation time, procedure time and fluoroscopy time were significantly shorter in the group using the Attain Select Ⅱ catheter delivery system; LV lead implantation time from （51-7） minutes to （40±7） minutes （P ＜0.001）, procedure time from （143±17） minutes to （124±18）minutes （P=0.001）, and fluoroscopy time from （45±7） minutes to （35±6） minutes （P＜0.001）. A successful procedure of LV lead implantation was significantly improved from 17/23 （74%） patients using the standard techniques and equipment, to 20/21 （95.3%） patients using the Attain Select Ⅱ catheter delivery system （P=0.06）Conclusion It is feasible and safe to implant LV leads through the coronary sinus using the Attain Select Ⅱ catheter delivery system.展开更多
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 patt...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.展开更多
Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but ...Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but compared to standard bipolar leads they have limitations related to maneuverability and high pacing thresholds. The ability of standard bipolar leads to overcome PNS is explored here. Methods: The French multicenter, observational study ORPHEE enrolled 90 CRT-D-eligible patients. Detection of PNS took place after satisfactory positioning of the LV bipolar lead (stable pacing threshold - LV ring, LV tip - RV ring and LV ring - RV coil) could prevent PNS from occurring in at least 90% of patients. Results: In 80 evaluable patients, PNS was reported in 12 patients (15%). Reprogramming overcame PNS in 10 patients: LV ring - RV coil in 8 patients;LV tip - LV ring in 1;and LV tip- RV ring in 1. As PNS was avoided in 78 of 80 patients (97.5%), the primary endpoint was significant (97.5% vs. 90%, p = 0.01). Conclusion: During CRT-D implantation, PNS occurred in 15% of patients. In most (97.5%) implanted patients, PNS could be avoided by vector reprogramming using a bipolar LV lead. For patients whose coronary sinus anatomy precludes the implantation of multi-electrode leads, bipolar leads are a suitable, reliable alternative.展开更多
目的探讨电生理标测冠状静脉窦(CS)分支最延迟电激动处植入左室导线行心脏再同步治疗(CRT)。方法 10例中重度心力衰竭患者,均满足NYHA心功能Ⅲ～Ⅳ级,左室射血分数(LVEF)<0.35且QRS波时限≥120 ms。CRT术中在可植入左室导线的CS分支...目的探讨电生理标测冠状静脉窦(CS)分支最延迟电激动处植入左室导线行心脏再同步治疗(CRT)。方法 10例中重度心力衰竭患者,均满足NYHA心功能Ⅲ～Ⅳ级,左室射血分数(LVEF)<0.35且QRS波时限≥120 ms。CRT术中在可植入左室导线的CS分支内进行电生理标测,将标测的最延迟心室电激动处作为左室导线的植入部位,观察该方法的可行性及临床疗效。结果 10例中,扩张型心肌病7例,缺血性心脏病3例;7例为窦性心律,3例为心房颤动;9例ECG表现为左束支传导阻滞,1例为室内传导阻滞。对10例的28个可作为左室导线植入部位的CS分支进行了电生理标测,10例均成功将左室导线植入在标测的最延迟电激动处,该处局部电位较体表ECG的QRS波起始延迟116±28 ms。术后即刻QRS波时限为121±17 ms,比术前153±30 ms明显缩短,P<0.01。8例CRT术后随访时间超过3个月,均有CRT应答(8/8,100%),其中3例超应答(3/8,37.5%),另外1例缺血性心肌病患者CRT术后2个月死于急性前壁心肌梗死;8例CRT应答患者NYHA心功能分级、6 min步行距离、LVEF值、左室收缩末容积、二尖瓣返流速度均较术前明显改善(1.6±0.5级vs 3.3±0.5级;405±92 m vs 307±82m;0.42±0.06 vs 0.30±0.04;121±38 ml vs 153±44 ml;3.9±1.2 m/s vs 4.5±1.5 m/s,P均<0.01)。结论电生理标测指引CS分支最延迟电激动处植入左室导线的CRT方法可行且短期疗效明显。展开更多
目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测...目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。展开更多
基金supported in part by grants from the Science and Technology Key Foundation of Guangdong Province(No.2010B031600166)the Science and Technology Foundation of Guangdong Province(No.2011B061300072)
文摘Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
文摘Background Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy （CRT） devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very sharply-angulated or tortuous of the lateral or posterolateral cardiac vein.Methods Totally 44 patients, 28 males and 16 females, with congestive heart failure and intraventricular conduction delay were studied retrospectively. There were 23 patients who had left ventricular （LV） lead implantation using standard techniques and equipment. For the other 21 patients with LV lead implantation we used the Attain Select Ⅱ catheter delivery system. The patients were seen every 3-6 months for 12 months and the efficacy of the primary procedure, LV lead implantation time, procedure and fluoroscopy time and the complications associated with the two techniques were evaluated.Results There were no significant differences in the age, gender, New York Heart Association （NYHA） functional class,ischemic etiology, QRS duration, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and LV dyssynchrony between the two groups. The LV lead implantation time, procedure time and fluoroscopy time were significantly shorter in the group using the Attain Select Ⅱ catheter delivery system; LV lead implantation time from （51-7） minutes to （40±7） minutes （P ＜0.001）, procedure time from （143±17） minutes to （124±18）minutes （P=0.001）, and fluoroscopy time from （45±7） minutes to （35±6） minutes （P＜0.001）. A successful procedure of LV lead implantation was significantly improved from 17/23 （74%） patients using the standard techniques and equipment, to 20/21 （95.3%） patients using the Attain Select Ⅱ catheter delivery system （P=0.06）Conclusion It is feasible and safe to implant LV leads through the coronary sinus using the Attain Select Ⅱ catheter delivery system.
基金supported by a grant form a Program of Science and Technology Development of Hubei Province (2004AA304B09).
文摘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.
文摘Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but compared to standard bipolar leads they have limitations related to maneuverability and high pacing thresholds. The ability of standard bipolar leads to overcome PNS is explored here. Methods: The French multicenter, observational study ORPHEE enrolled 90 CRT-D-eligible patients. Detection of PNS took place after satisfactory positioning of the LV bipolar lead (stable pacing threshold - LV ring, LV tip - RV ring and LV ring - RV coil) could prevent PNS from occurring in at least 90% of patients. Results: In 80 evaluable patients, PNS was reported in 12 patients (15%). Reprogramming overcame PNS in 10 patients: LV ring - RV coil in 8 patients;LV tip - LV ring in 1;and LV tip- RV ring in 1. As PNS was avoided in 78 of 80 patients (97.5%), the primary endpoint was significant (97.5% vs. 90%, p = 0.01). Conclusion: During CRT-D implantation, PNS occurred in 15% of patients. In most (97.5%) implanted patients, PNS could be avoided by vector reprogramming using a bipolar LV lead. For patients whose coronary sinus anatomy precludes the implantation of multi-electrode leads, bipolar leads are a suitable, reliable alternative.
文摘目的探讨电生理标测冠状静脉窦(CS)分支最延迟电激动处植入左室导线行心脏再同步治疗(CRT)。方法 10例中重度心力衰竭患者,均满足NYHA心功能Ⅲ～Ⅳ级,左室射血分数(LVEF)<0.35且QRS波时限≥120 ms。CRT术中在可植入左室导线的CS分支内进行电生理标测,将标测的最延迟心室电激动处作为左室导线的植入部位,观察该方法的可行性及临床疗效。结果 10例中,扩张型心肌病7例,缺血性心脏病3例;7例为窦性心律,3例为心房颤动;9例ECG表现为左束支传导阻滞,1例为室内传导阻滞。对10例的28个可作为左室导线植入部位的CS分支进行了电生理标测,10例均成功将左室导线植入在标测的最延迟电激动处,该处局部电位较体表ECG的QRS波起始延迟116±28 ms。术后即刻QRS波时限为121±17 ms,比术前153±30 ms明显缩短,P<0.01。8例CRT术后随访时间超过3个月,均有CRT应答(8/8,100%),其中3例超应答(3/8,37.5%),另外1例缺血性心肌病患者CRT术后2个月死于急性前壁心肌梗死;8例CRT应答患者NYHA心功能分级、6 min步行距离、LVEF值、左室收缩末容积、二尖瓣返流速度均较术前明显改善(1.6±0.5级vs 3.3±0.5级;405±92 m vs 307±82m;0.42±0.06 vs 0.30±0.04;121±38 ml vs 153±44 ml;3.9±1.2 m/s vs 4.5±1.5 m/s,P均<0.01)。结论电生理标测指引CS分支最延迟电激动处植入左室导线的CRT方法可行且短期疗效明显。
文摘目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。
