Journal articles: 'Cardiac pacing lead'

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Hickey, Cheryl Schneider, and Linda S. Baas. "Temporary Cardiac Pacing." AACN Advanced Critical Care 2, no. 1 (February 1, 1991): 107–17. http://dx.doi.org/10.4037/15597768-1991-1018.

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The use of temporary cardiac pacing in critical care and stepdown units has grown tremendously over the past 10 years. While the concept of artificial pacing is simple, improvements in generator technology and lead design, along with broader clinical applications, have made temporary cardiac pacing more complex. Consequently, the critical care nurse is required to maintain an advanced level of knowledge regarding modes and complications of temporary pacing, and assessment skills related to recognizing pacemaker hemodynamic effects and pacemaker problems

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Curnis, Antonio, David O’Donnell, Axel Kloppe, and Žarko Calovic. "Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing." Arrhythmia & Electrophysiology Review 4, no. 3 (2015): 3. http://dx.doi.org/10.15420/aer.2015.4.3.sup1.

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Cardiac resynchronisation therapy (CRT) using biventricular pacing is an established therapy for impairment of left ventricular (LV) systolic function in patients with heart failure (HF). Although technological advances have improved outcomes in patients undergoing biventricular pacing, the optimal placement of pacing leads remains challenging, and approximately one third of patients have no response to CRT. This may be due to patient selection and lead placement. Electrical mapping can greatly improve outcomes in CRT and increase the number of patients who derive benefit from the procedure. MultiPoint™ pacing (St Jude Medical, St Paul, MN, US) using a quadripolar lead increases the possibility of finding the best pacing site. In clinical studies, use of MultiPoint pacing in HF patients undergoing CRT has been associated with haemodynamic and clinical benefits compared with conventional biventricular pacing, and these benefits have been sustained at 12 months. This article describes the proceedings of a satellite symposium held at the European Heart Rhythm Association (EHRA) Europace conference held in Milan, Italy, in June 2015.

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Mitkowski, Przemysław. "Multisite, multipoint pacing." In a good rythm 2, no. 43 (May 24, 2017): 9–13. http://dx.doi.org/10.5604/01.3001.0010.3966.

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Cardiac resynchronization therapy in patients with heart failure, reduced ejection fraction and prolonged QRS duration has become standard of care. Unfortunately, despite improvements in delivery of this treatment still approximately 30% of patients are non-responders. Among causes of this phenomenon one can find an inability to deliver hemodynamically effective left ventricular pacing. There were proposed several solutions to solve the problem, including: multisite RV pacing, multisite LV pacing, multipoint LV pacing. Multisite RV pacing (two RV leads positioned in RV: apex and RVOT), although causes some hemodynamic improvement in LVEF or distance in 6MWT and reduction of LVESD or number of hospitalizations in comparison to no paced patients, but its efficacy is significantly worse than normal CRT. So it should not be considered as an alternative to CRT even to surgically placed LV lead. Multisite LV pacing (two leads iv cardiac veins) gives significant benefits over standard CRT, especially in patients with poor heart vein system, which preclude optimal LV lead placement. Clinical benefits of this mode of therapy were observed in non-responders to classical CRT, and were proved in: higher responder rates, improved EF, VO2, distance in 6MWT, reduction of NYHA class, LVESV, LVEDD and increase of dP/dt. Multipoint LV pacing (different pacing point located on the same LV lead) is encouraging way of CRT delivery and does not require any additional lead. Benefits of MP pacing over classical CRT were proved in numerous trails in acute tests by improvement in dP/dt, increase in maximal strain rate, shortening of total activation time, reduction in QRS duration and after mid- and long term follow-up in reduction of LVESV, increase in EF, reduction of asynchrony and higher percentage of responders. Multipoint left ventricular pacing should be a standard of CRT delivery in first implantations.

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Miyagi, Chihiro, Yoshie Ochiai, Yusuke Ando, Manabu Hisahara, Hironori Baba, Tomoya Takigawa, and Shigehiko Tokunaga. "A case of cardiac strangulation following epicardial pacemaker implantation." General Thoracic and Cardiovascular Surgery 68, no. 12 (April 8, 2020): 1499–502. http://dx.doi.org/10.1007/s11748-020-01337-y.

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AbstractAn 8-year-old boy had undergone permanent epicardial pacemaker implantation with a Y-shaped bipolar ventricular lead on day 6 after birth for treatment of congenital complete atrioventricular block. He was found to have pulmonary stenosis and mitral stenosis by follow-up echocardiography. Further studies including computed tomography and cardiac catheterization revealed that the pacemaker lead had completely encircled the cardiac silhouette and was in a state of “cardiac strangulation”. We removed the previous pacing leads and generator and implanted a new epicardial dual-chamber pacing system in the right atrium and right ventricle. Additionally, an expanded polytetrafluoroethylene sheet was placed between the new leads and the heart to prevent recurrence of cardiac strangulation.

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Nowak, Bernd, Thomas Voigtla¨nder, Ewald Himmrich, Andreas Liebrich, Gerald Poschmann, Sigrid Epperlein, Norbert Treese, and Ju¨rgen Meyer. "Cardiac output in single-lead VDD pacing versus rate-matched VVIR pacing." American Journal of Cardiology 75, no. 14 (May 1995): 904–7. http://dx.doi.org/10.1016/s0002-9149(99)80684-5.

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Donovan, Karl D., and K. Y. Lee. "Indications for and Complications of Temporary Transvenous Cardiac Pacing." Anaesthesia and Intensive Care 13, no. 1 (February 1985): 63–70. http://dx.doi.org/10.1177/0310057x8501300109.

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A prospective survey was conducted of the indications for and complications of 153 temporary transvenous cardiac pacing lead insertions in 148 patients. Pacing for bradyarrhythmias or potential bradyarrhythmias (Group I) accounted for 105 insertions, wide complex tachycardia (Group II) 17, and narrow complex tachycardia (Group III) 31 pacing electrode insertions respectively. The infraclavicular subclavian vein approach was used in 73%. The median insertion time was 20 minutes. Group I: 77% were undertaken because of severe symptoms. On 64 occasions (61 %) the patient had complete heart block or ventricular asystole. Group II: The lead was inserted to treat and often assist in the diagnosis of the wide complex tachycardia. Ventricular‘burst’ pacing reverted ventricular tachycardia in 13 (76%). Group III: Rapid atrial‘burst’ pacing was used to treat supraventricular tachyarrhythmias (paroxysmal supraventricular tachycardia and atrial flutter) resistant to medical therapy. Pacing was successful in reverting 28 (90%). A complication occurred in 27 (18%) of 153 lead insertions, 11 (7%) were serious. No complication resulted in the death of a patient. Temporary transvenous pacing is safe and effective for the treatment of bradyarrhythmias and certain tachyarrhythmias.

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Nesher, Nahum, Amir Ganiel, Yosef Paz, Amir Kramer, Refael Mohr, Yanai Ben-Gal, and Demitri Pevni. "Thoracoscopic Epicardial Lead Implantation as an Alternative to Failed Endovascular Insertion for Cardiac Pacing and Resynchronization Therapy." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 6 (November 2014): 427–31. http://dx.doi.org/10.1177/155698451400900606.

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Objective Numerous anomalies or postprocedural stricture of the venous system prevent optimal endovascular implantation of a pacing lead in more than 10% of patient indicated for permanent pacing or cardiac resynchronization therapy. The purpose of this report was to summarize our experience and immediate postoperative results of thoracoscopic lead implantation as a lesser invasive solution to an unsuccessful endovascular lead insertion. Methods From January 2008 to April 2013, 11 epicardial leads were introduced thoracoscopically at our center as a rescue treatment after failed endovascular attempts. Patients were ventilated using a double-lumen endotracheal tube. A 5-mm 30-degree lance thoracoscope was used with either 2 or 3 additional working ports. A screw-in pacing lead (Medtronic Model 5071 Pacing lead, Minneapolis, MN USA) was inserted into the left ventricular epicardium. After the lead placement and assessment for threshold less than 1 V, the lead was brought to the chest wall and tunneled to the pacemaker generator pocket. At the end of the procedure, a small, flexible 14F thoracic drain, was left inside the pleural cavity for the next 24 hours. Results There were no mortality or any major surgical complications among these patients. All patients responded to the epicardial lead implantation in terms of appropriate pacing and conductivity. No clinical failure was observed, and no patient required a repeat procedure. Conclusions Thoracoscopic lead insertion is safe and easy to perform. We believe it should be offered as the first choice after failed endovascular pacing lead implantation.

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Luzi, Giampaolo, Andrea Montalto, Vincenzo Polizzi, Cesare C. D'Alessandro, Mariano Vicchio, and Francesco Musumeci. "Best Site on Right Ventricle for Open-Chest Biventricular Pacing." Asian Cardiovascular and Thoracic Annals 15, no. 5 (October 2007): 427–31. http://dx.doi.org/10.1177/021849230701500514.

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Cardiac resynchronization therapy is effective in patients with a low ejection fraction and left bundle branch block, but 20%–30% do not respond despite selection of the optimal site for pacing on the left ventricle. We investigated whether optimizing the site for placement of the pacing lead on the right ventricle could further improve left ventricular function during cardiac resynchronization in 19 patients (mean age, 63 ± 5 years) undergoing coronary artery bypass with post-ischemic dilated myocardiopathy (ejection fraction, 25.8% ± 2%) and left bundle branch block. The hemodynamic response to pacing was tested with the right ventricular lead positioned at the interventricular septum, atrioventricular junction, acute margin, and the pulmonary trunk. Biventricular stimulation improved left ventricular function. When the right ventricular lead was sited at the interventricular septum, a significant improvement in all hemodynamic parameters compared to the other sites was obtained. Biventricular pacing is important to optimize cardiac resynchronization. Although further studies are needed to confirm these findings, accurate lead placement is recommended for cardiac resynchronization therapy in patients with poor cardiac function and left bundle branch block.

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Laske, Timothy G., Nicholas D. Skadsberg, and Paul A. Iaizzo. "A Novel Ex Vivo Heart Model for the Assessment of Cardiac Pacing Systems." Journal of Biomechanical Engineering 127, no. 6 (June 28, 2005): 894–98. http://dx.doi.org/10.1115/1.2049312.

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Background: Advances in endocardial device design have been limited by the inability to visualize the device-tissue interface. The purpose of this study was to assess the validity of an isolated heart approach, which allows direct ex vivo intracardiac visualization, as a research tool for studying endocardial pacing systems. Method of approach: Endocardial pacing leads were implanted in the right atria and ventricles of intact swine (n=8) under fluoroscopic guidance. After collection of pacing and sensing performance parameters, the hearts were excised with the leads intact and reanimated on the isolated heart apparatus, and parameters again recorded. Results: Atrial ex vivo parameters significantly decreased compared with in vivo measurements: P-wave amplitudes by 39%, slew rates by 61%, and pacing impedances by 42% (p<0.05 for each). Similarly, several ventricular ex vivo parameters decreased: R-wave amplitudes by 39%, slew rates by 62%, and pacing impedances by 31%. In contrast, both atrial (4.4±2.8 vs 3.3±2.8V; p=ns) and ventricular thresholds increased (1.2±0.7 vs 0.6±0.1V; p<0.05 for all). Three distinct phenomena were observed at the lead-tissue interface. Normal implants (70%) demonstrated minimal tissue distortion and resulted in elevated impedance and threshold values. Three implants (13%) resulted in severe tissue distortion and/or tissue wrapping and were associated with highly elevated pacing parameters. Tissue coring occurred in four implants (17%) where the lead would spin freely in the tissue after overtorquing of the lead. Conclusions: The utility of the isolated heart approach was demonstrated as a tool for the design and assessment of the performance of endocardial pacing systems. Specifically, the ability to visualize device-heart interactions allows new insights into the impact of product design and clinical factors on lead performance and successful implantation.

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Qian, Zhiyong, Yuanhao Qiu, Yao Wang, Zeyu Jiang, Hongping Wu, Xiaofeng Hou, and Jiangang Zou. "Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience." EP Europace 22, Supplement_2 (December 2020): ii45—ii53. http://dx.doi.org/10.1093/europace/euaa295.

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Abstract Aims His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre. Methods and results Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P < 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P < 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of >1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF <50%, both HB and LBB pacing improved clinical outcomes during follow-up. Conclusion His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.

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Vicente-Miralles, Raimundo, David Alejandro Martín-Langerwerf, José María Núñez-Martínez, Ana Marco-Juan, Antonio Domenico Sangio-Ferreyros, Adriana Dávila-Arias, Laura Montes-Jacobo, et al. "A new fastening system for temporary pacing with active-fixation leads: effectiveness and safety." European Heart Journal. Acute Cardiovascular Care 11, no. 3 (December 17, 2021): 224–29. http://dx.doi.org/10.1093/ehjacc/zuab119.

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Abstract Aims Temporary cardiac pacing with active-fixation leads (TPAFL) using a reusable permanent pacemaker generator has been shown to be safer than lead systems without fixation. However, TPAFL requires the off-label use of pacemaker leads and generators. We designed a fastening system to ensure the safety and efficacy of the procedure: the KronoSafe System®. To demonstrate the safety and effectiveness of the KronoSafe System® for temporary pacing in a series of patients receiving TPAFL. Methods and results A prospective cohort of 20 patients undergoing TPAFL between August 2019 and June 2020 was recruited in a Spanish region. The temporary pacemaker was implanted through jugular access and secured with the KronoSafe System®. R-wave detection, lead impedance, and capture threshold were assessed every 48 h. Complications associated with the procedure or occurring during TPAFL were recorded. There were no complications associated with temporary pacing, and the therapy was effective in all cases. TPAFL was used for a mean of 7.6 days (maximum 25 days), and 84.56% of the time in a cardiology ward. Conclusion TPAFL secured using the KronoSafe system® provides safe and stable cardiac stimulation for patients requiring temporary cardiac pacing.

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Jastrzębski, Marek. "Novelties in cardiac pacing. Left bundle branch pacing, a step-by-step guide." In a good rythm 2, no. 59 (September 30, 2021): 27–41. http://dx.doi.org/10.5604/01.3001.0015.4536.

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Left bundle branch pacing (LBBP) technique is a new method for conduction system pacing that is useful for both bradyarrhythmia and heart failure indications. LBBP, while less physiological than His bundle pacing, offers several practical advantages. Namely, lower and stable pacing thresholds, good sensing of the intrinsic ventricular activity and easiness in localizing the pacing target. The LBBP method more often than His bundle pacing results in engagement of the conduction system distal to the area of the block. A step-by-step approach to LBBP was described. Attention was given to the following phases of the procedure: 1) localization of the target area on the septum, 2) the lead rotation technique with an interpretation of the lead responses (drill effect, screwdriver effect, entanglement effect), 3) methods for monitoring the lead depth in the septum to avoid perforation (fixation beats, continuous pace mapping, impedance), and 4) methods to differentiate between LBBP and left ventricular septal pacing.

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JONES, MICHAEL A., RAJ KHIANI, PAUL FOLEY, DAVID WEBSTER, NORMAN QURESHI, KELVIN C. K. WONG, KIM RAJAPPAN, YAVER BASHIR, and TIMOTHY R. BETTS. "Inter- and Intravein Differences in Cardiac Output with Cardiac Resynchronization Pacing using a Multipolar LV Pacing Lead." Pacing and Clinical Electrophysiology 38, no. 2 (November 20, 2014): 267–74. http://dx.doi.org/10.1111/pace.12531.

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Bax, Jeroen J., and Victoria Delgado. "Cardiac Resynchronization Therapy With Multipoint Left Ventricular Lead Pacing." JACC: Clinical Electrophysiology 3, no. 13 (December 2017): 1519–22. http://dx.doi.org/10.1016/j.jacep.2017.10.013.

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Dwyer, Diane, and Kelly Bauer. "Take the lead on safety with temporary cardiac pacing." Nursing 40, no. 3 (March 2010): 63–64. http://dx.doi.org/10.1097/01.nurse.0000368826.43217.d8.

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Bracke, F. "Complications and lead extraction in cardiac pacing and defibrillation." Netherlands Heart Journal 16, no. 1 (January 2008): 27–30. http://dx.doi.org/10.1007/bf03086202.

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Parahuleva, Mariana S., Ritvan Chasan, Nedim Soydan, Yasser Abdallah, Christiane Neuhof, Harald Tillmanns, and Ali Erdogan. "Quadripolar Left Ventricular Lead in a Patient with CRT-D does Not Overcome Phrenic Nerve Stimulation." Clinical Medicine Insights: Cardiology 5 (January 2011): CMC.S6759. http://dx.doi.org/10.4137/cmc.s6759.

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Effective cardiac resynchronization therapy (CRT) requires an accurate atrio-biventricular pacing system. The innovative Quartet lead is a quadripolar, over-the-wire left ventricular lead with four electrodes and has recently been designed to provide more options and greater control in pacing vector selection. A lead with multiple pacing electrodes is a potential alternative to physical adjustment of the lead and may help to overcome high thresholds and phrenic nerve stimulation (PNS).

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Norton, Caleb, Benjamin Holmes, Asad Al Aboud, Eun-Jeong Kim, Holly Gonzales, Christopher Ellis, Roy John, George H. Crossley, and Jay Montgomery. "Transvenous Extraction and Removal of Pacing Leads Placed after Cardiac Transplantation." Case Reports in Cardiology 2019 (January 3, 2019): 1–4. http://dx.doi.org/10.1155/2019/6270950.

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There is an increasing prevalence of cardiac implantable electronic devices (CIEDs) due to expanding adoption and availability of these evidence-based therapies. With the increased prevalence of these life-saving devices, there has also been an increased demand for lead removal and lead extraction. Understanding the specific subgroups of patients at high risk for complications during and after lead extraction has become imperative to properly manage endovascular CIED leads. There have been multiple published studies describing clinical variables that predict adverse outcomes in CIED system extractions; however, the risk of complications in leads placed after cardiac transplantation has not specifically been addressed to date. We present four cases of transvenous extraction and removal of pacing leads placed after cardiac transplantation. There were no major complications related to extraction in these four cases; however, three of the four patients died within one year after the procedure. While the etiology of death in these cases seemed to be unrelated to the extraction procedure, the indications for extraction (infection in the setting of immunosuppression and calcineurin-associated ESRD and poor sensing/capture possibly secondary to chronic rejection and/or frequent right heart biopsies) likely contributed at least indirectly to the subsequent death.

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AlHuzaimi, Abdullah, Nathalie Roy, and Walter J. Duncan. "Cardiac strangulation from epicardial pacemaker: early recognition and prevention." Cardiology in the Young 21, no. 4 (March 17, 2011): 471–73. http://dx.doi.org/10.1017/s1047951111000242.

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AbstractCardiac strangulation from epicardial pacemaker leads is a rare event that can be difficult to recognise and can cause serious complications such as cardiac failure or death. We describe a 3-year-old girl who received an epicardial pacing system as a neonate for complete congenital cardiac block and developed cardiac strangulation from the leads. The clinical presentation modes are reviewed and technical aspects for lead and generator positioning are discussed.

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Gózd-Barszczewska, Anna, Wojciech Dworzański, Marcin Szczasny, Marcin Leus, Tomasz Chromiński, and Ryszard Grzywna. "Additional Great cardiac vein." In a good rythm 1, no. 46 (March 22, 2018): 36–39. http://dx.doi.org/10.5604/01.3001.0011.6498.

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We report a case of a patient with an additional great cardiac vein, discovered during the implantation for cardiac resynchronization therapy (CRT). Anomalies of the coronary sinus and its tributaries may cause difficulties in appropriate implantation of the left ventricular lead but they can also be considered as alternatives for lead placement. Although unusual angiogram of the coronary venous system, a left ventricular pacing lead was successfully placed in the left marginal vein. To settle diagnostic doubts, multislice computed tomography was carried out.

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Fletcher, Lisa. "The leadless pacemaker and cardiac nursing care." British Journal of Cardiac Nursing 15, no. 11 (November 2, 2020): 1–10. http://dx.doi.org/10.12968/bjca.2020.0059.

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A leadless intracardiac transcatheter pacing system has been designed to overcome the need for a pacemaker pocket and transvenous lead. Currently, the leadless pacemaker only offers VVI/R pacing and cannot provide atrial pacing. Additional clinical data are required to enable comparison with transvenous devices. In order to prepare a patient for the procedure, nurses need to understand the rationale and treatment options, including risk factors to ensure that patient safety remains central to all care. This article reviews leadless pacemakers as a treatment option, explores the key aspects of nursing care and analyses the complications of these pacemakers.

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Bodin, Alexandre, Arnaud Bisson, Clémentine Andre, Bertrand Pierre, Laurent Fauchier, Dominique Babuty, and Nicolas Clementy. "Multisite pacing via a quadripolar lead for cardiac resynchronization therapy." Journal of Interventional Cardiac Electrophysiology 56, no. 1 (July 18, 2019): 117–25. http://dx.doi.org/10.1007/s10840-019-00592-1.

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Riley, D. P., and P. A. Hales. "Transcutaneous Cardiac Pacing for Asystole during Permanent Pacemaker Lead Repositioning." Anaesthesia and Intensive Care 20, no. 4 (November 1992): 524–25. http://dx.doi.org/10.1177/0310057x9202000428.

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Kirchgesner, T., B. Ghaye, S. Marchandise, J. B. Le Polain de Waroux, and E. Coche. "Iatrogenic cardiac perforation due to pacing lead displacement: Imaging findings." Diagnostic and Interventional Imaging 97, no. 2 (February 2016): 233–38. http://dx.doi.org/10.1016/j.diii.2015.03.011.

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Pescariu, Silvius-Alexandru, Raluca Şoşdean, Bogdan Enache, Răzvan I. Macarie, Mariana Tudoran, Cristina Tudoran, Cristian Mornoş, Adina Ionac, and Sorin Pescariu. "Single-Pass VDD Pacing Lead for Cardiac Resynchronization Therapy: A Reliable Alternative." Micromachines 12, no. 8 (August 18, 2021): 978. http://dx.doi.org/10.3390/mi12080978.

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(1) Background: Cardiac resynchronization therapy (CRT) systems can be simplified by excluding the atrial lead and using a Ventricular-Dual-Dual (VDD) pacing lead. Possible disadvantages might include atrial undersensing and Ventricular-Ventricular-Inhibition (VVI) pacing. Because literature data concerning these systems are scarce, we analyzed their benefits and technical safety. (2) Methods: this retrospective study compared 50 patients implanted with VDD–CRT systems (group A), mainly because of unfavorable venous anatomy concerning the complication rate, with 103 subjects with Dual-Dual-Dual (DDD)–CRT systems (group B) implanted during 2000–2016 and 49 (group C) during 2016–2020. To analyze the functional parameters of the devices, we selected subgroups of 27 patients (subgroup A) and 47 (subgroup B) patients with VDD–CRT in 2000–2016, and 36 subjects (subgroup C) with DDD–CRT implanted were selected in 2017–2020. (3) Results: There was a trend of a lower complication rate with VDD–CRT systems, especially concerning infections during 2000–2016 (p = 0.0048), but similar results were obtained after rigorous selection of patients and employment of an upgraded design of devices/leads. With a proper device programing, CRT pacing had similar results, atrial undersensing being minimal (p = 0.65). For VDD-systems, VVI pacing was recorded only 1.7 ± 2.24% of the time. (4) Conclusions: In patients with a less favorable venous anatomy, VDD–CRT systems may represent a safe alternative regarding complications rates and functional parameters.

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Apostol, Adrian, Nicolae Albulescu, Stela Iurciuc, Mircea Iurciuc, Carina Bogdan, and Mihaela Viviana Ivan. "Difference in Cardiac Electrical Vulnerability Between Passive Silicone Steroid Eluting Lead vs. Active Screw-in Lead." Materiale Plastice 56, no. 4 (December 30, 2019): 968–72. http://dx.doi.org/10.37358/mp.19.4.5293.

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Patients with total atrioventricular block are of particular interest and prone to severe prognosis unless treated with emergency cardiac pacing. We evaluated different types of leads and their impact on the myocardium, according to the fixation type and pacing method.. A pacemaker patient has a different depolarization pattern and a single chamber pacemaker, has by definition, an intracardiac desynchronization and a different electro-mechanical coupling activity. The presence of late potentials is an independent prognosis factor for cardiac death and electrical vulnerability, especially after myocardial infarction(MI). Late potentials recorded as magnitude vector are the expresion of late depolarization of the surrounding tissue and represent the morfological substrate for reentry. Thus, the incidence of late potentials after pacemaker implant, represents the expresion of electrical vulnerability of the stimulated right ventricular myocardium. In order to deeply study the parameters of magnitude vectors, we noticed the appearance of late potentials during the transitory stimulation in acute atrioventricular block and a restoration of vector normal parameters, after conduction recovery and sinus rhythm conversion.

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Mabo, P., and G. Carrault. "Are Electronic Cardiac Devices Still Evolving?" Yearbook of Medical Informatics 23, no. 01 (August 2014): 128–34. http://dx.doi.org/10.15265/iy-2014-0021.

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Summary Objectives: The goal of this paper is to review some important issues occurring during the past year in Implantable devices. Methods: First cardiac implantable device was proposed to maintain an adequate heart rate, either because the heart’s natural pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. During the last forty years, pacemakers have evolved considerably and become programmable and allow to configure specific patient optimum pacing modes. Various technological aspects (electrodes, connectors, algorithms diagnosis, therapies, ...) have been progressed and cardiac implants address several clinical applications: management of arrhythmias, cardioversion / defibrillation and cardiac resynchronization therapy. Results: Observed progress was the miniaturization of device, increased longevity, coupled with efficient pacing functions, multisite pacing modes, leadless pacing and also a better recognition of supraventricular or ventricular tachycardia’s in order to deliver appropriate therapy. Subcutaneous implant, new modes of stimulation (leadless implant or ultrasound lead), quadripolar lead and new sensor or new algorithm for the hemodynamic management are introduced and briefly described. Each times, the main result occurring during the two past years are underlined and repositioned from the history, remaining limitations are also addressed. Conclusion: Some important technological improvements were described. Nevertheless, news trends for the future are also considered in a specific session such as the remote follow-up of the patient or the treatment of heart failure by neuromodulation.

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Fang, H. R., T. Tang, X. M. Zhang, Zhuo Zhuang, Wei Yang, and Ying Zhao. "Finite Element Modeling of Cardiac Pacing/Defibrillation Lead Interaction with Heart." Key Engineering Materials 306-308 (March 2006): 1271–76. http://dx.doi.org/10.4028/www.scientific.net/kem.306-308.1271.

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The hyperelastic constitutive model of cardiac muscle is developed based on the animal surgical operation and mechanical experiments from the heart of the dogs, and the relaxation phenomena is also studied based on the Hill three elements model which is viscoelastic. Some numerical simulations are presented by finite element for the cardiac pacing/defibrillation lead interaction with muscles of the heart.

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Hou, Xiaofeng, Zhiyong Qian, Yao Wang, Yuanhao Qiu, Xing Chen, Hai Jiang, Zeyu Jiang, et al. "Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum." EP Europace 21, no. 11 (July 19, 2019): 1694–702. http://dx.doi.org/10.1093/europace/euz188.

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Abstract Aims Left bundle branch pacing (LBBP) recently emerges as a novel pacing modality. We aimed to evaluate the feasibility and cardiac synchrony of permanent LBBP in bradycardia patients. Methods and results Left bundle branch pacing was successfully performed in 56 pacemaker-indicated patients with normal cardiac function. Left bundle branch pacing was achieved by penetrating the interventricular septum (IVS) into the left side sub-endocardium with the pacing lead. His-bundle pacing (HBP) was successfully performed in another 29 patients, 19 of whom had right ventricular septal pacing (RVSP) for backup pacing. The QRS duration, left ventricular (LV) activation time (LVAT), and mechanical synchrony using phase analysis of gated SPECT myocardial perfusion imaging were evaluated. Paced QRS duration in LBBP group was significantly shorter than that in RVSP group (117.8 ± 11.0 ms vs. 158.1 ± 11.1 ms, P < 0.0001) and wider than that in HBP group (99.7 ± 15.6 ms, P < 0.0001). Left bundle branch potential was recorded during procedure in 37 patients (67.3%). Left bundle branch pacing patients with potential had shorter LVAT than those without potential (73.1 ± 11.3 ms vs. 83.2 ± 16.8 ms, P = 0.03). Left bundle branch pacing patients with potential had similar LV mechanical synchrony to those in HBP group. R-wave amplitude and capture threshold of LBBP were 17.0 ± 6.7 mV and 0.5 ± 0.1 V, respectively at implant and remained stable during a mean follow-up of 4.5 months without lead-related complications. Conclusion Permanent LBBP through IVS is safe and feasible in bradycardia patients. Left bundle branch pacing could achieve favourable cardiac electrical and LV mechanical synchrony.

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Arora, Vanita, and Pawan Suri. "Physiological Pacing: A New Road to Future." Indian Journal of Clinical Cardiology 2, no. 1 (February 6, 2021): 32–43. http://dx.doi.org/10.1177/2632463620978045.

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Anatomy and physiology are the basis of human body functioning and as we have progressed in management of various diseases, we have understood that physiological intervention is always better than an anatomical one. For more than 50 years, a standard approach to permanent cardiac pacing has been an anatomical placement of transvenous pacing lead at the right ventricular apex with a proven benefit of restoring the rhythm. However, the resultant ventricular dyssynchrony on the long-term follow-up in patients requiring more than 40% ventricular pacing led to untoward side effects in the form of heart failure and arrhythmias. To counter such adverse side effects, a need for physiological cardiac pacing wherein the electrical impulse be transmitted directly through the normal conduction system was sought. His bundle pacing (HBP) with an intriguing alternative of left bundle branch pacing (LBBP) is aimed at restoring such physiological activation of ventricles. HBP is safe, efficacious, and feasible; however, localization and placement of a pacing lead at the His bundle is challenging with existing transvenous systems due to its small anatomic size, surrounding fibrous tissue, long-learning curve, and the concern remains about lead dislodgement and progressive electrical block distal to the HBP lead. In this article, we aim to take the reader through the challenging journey of HBP with focus upon the hardware and technique, selective versus nonselective HBP, indications and potential disadvantages, and finally the future prospects.

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Kim, Hye Ree, Kyunghee Lim, Seung-Jung Park, Jong-Sung Park, Ju Youn Kim, Suryeun Chung, Dong-Seop Jung, Kyoung-Min Park, Young Keun On, and June Soo Kim. "Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy." Journal of Cardiovascular Development and Disease 9, no. 5 (May 16, 2022): 160. http://dx.doi.org/10.3390/jcdd9050160.

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(1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches.

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Schmidt, Mandi, Amara Estrada, Jim VanGilder, Herbert Maisenbacher, and Robert Prosek. "Safety and Feasibility of Transesophageal Pacing in a Dog." Journal of the American Animal Hospital Association 44, no. 1 (January 1, 2008): 19–24. http://dx.doi.org/10.5326/0440019.

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This study investigated the feasibility of using a modified transesophageal atrial pacing system for dogs requiring temporary ventricular pacing. Atrial pacing was readily achieved in the one dog studied, but it caused considerable diaphragmatic movement. Ventricular pacing could not be achieved at any lead configuration or energy stimulation. While transesophageal cardiac pacing was a safe procedure, the large variation in the chest anatomy of dogs requires further study to explore this model as a substitute for transvenous or transthoracic ventricular pacing.

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Perepeka, Eugene O., Borys B. Kravchuk, Oksana M. Paratsii, Liliana M. Hrubyak, Volodymyr L. Leonchuk, and Maryna M. Sychyk. "Transventricular Left Bundle Branch Pacing." Ukrainian Journal of Cardiovascular Surgery 30, no. 1 (46) (March 23, 2022): 89–93. http://dx.doi.org/10.30702/ujcvs/22.30(01)/pk016-8993.

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Background. Implementation of conduction system permanent pacing methods in patients with cardiac bradyarrhythmias allows to maintain the physiological sequence of excitation and contraction of the ventricles and to avoid the development of heart failure due to electrical and mechanical dyssynchrony in patients with high rates of ventricular pacing. Case description. A 61-year-old female patient was examined and treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 25 to January 27, 2022 at the department of surgical treatment of complex cardiac arrhythmias with a diagnosis of proximal complete atrioventricular block. A two-chamber pacemaker (Vitatron Q50A2) with a ventricular lead to stimulate the His bundle region (Medtronic 3830, 69 cm) was implanted to the patient with a special delivery system (C315HIS). At an X-ray operating room, 12 ECG leads from the electrophysiological station LabSystem Pro (Bard, USA) were connected to the patient to analyze the criteria for capturing the conduction system on stimulation during ventricular lead placement, and a diagnostic quadripolar electrode was inserted into the right ventricle to record the potential of the His bundle as an X-ray reference point. During placement of the ventricular lead in the area of the His bundle due to high pacing thresholds the decision was made to implement an alternative method of conduction system pacing – left bundle branch pacing through the interventricular septum. After gradual passage of the electrode through the septum, capture of the conduction system of the heart was achieved, although no clear potential of the left bundle was registered. The interval from stimulus to peak R wave in lead V6 was 68 ms, and the interval from stimulus to peak R wave in lead V1 was 110 ms. The difference between intervals was 42 ms, which indicated the criteria of nonselective capture of the left bundle branch, with stimulation thresholds below 1 V at a pulse length of 0.5 ms. In the postoperative period, the patient was evaluated for global longitudinal deformity of the left ventricle on constant ventricular stimulation, which was carried out according to standard methods using speckle-tracking echocardiography; no signs of dyssynchrony were found. Also, the location of the endocardial electrode in the middle segments of the interventricular septum on the right ventricular side was visualized and confirmed by performing B-mode transthoracic echocardiography with subcostal access. Conclusions. Left bundle branch pacing, like His bundle pacing, maintains electrical and mechanical synchrony of the left ventricle at lower pacing thresholds, greater amplitude of the sensitivity signal and lower risks of lead dislocation.

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Ni, Shimao, Changhao Jiang, and Zhili Chen. "A Comparative Study of Right Ventricular Apical Pacing and Right Ventricular Septal Pacing." Advanced Emergency Medicine 4, no. 1 (March 19, 2015): 14. http://dx.doi.org/10.18686/aem.v4i1.5.

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Objective: Assessment of cardiac function by the assessment of ventricular pacing and right ventricular apex pacing. Method: Analysis of 30 patients with VVI pacemaker (pacing RVA, right ventricular apical pacing RVS 15 cases) was analyzed, and the differences of cardiac function and pacing parameters were analyzed in one year. Results: There was no significant difference in the impedance, voltage threshold and R wave height between the 1 year after the effective pacing and the years after the pacing electrode. 1 year after the two groups of patients with significant differences in EF. Conclusion: Right ventricular septal pacing and right ventricular apical pacing are equally safe and effective, right ventricular apical pacing can lead to left ventricular systolic dysfunction and decreased left ventricular function.

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Beneyto, Maxime, Matthieu Seguret, Marine Taranzano, Pierre Mondoly, Caroline Biendel, Anne Rollin, Fanny Bounes, Meyer Elbaz, Philippe Maury, and Clément Delmas. "Externalized Reusable Permanent Pacemaker for Prolonged Temporary Cardiac Pacing in Critical Cardiac Care Units: An Observational Monocentric Retrospective Study." Journal of Clinical Medicine 11, no. 23 (December 4, 2022): 7206. http://dx.doi.org/10.3390/jcm11237206.

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Introduction: The use of temporary cardiac pacing is frequent in critical care units for severe bradycardia or electrical storm, but may be associated with frequent and potentially severe complications, especially when indwelling for several days. In some cases, transient indication or ongoing contraindication for a permanent pacemaker justifies prolonged temporary pacing. In that case, the implantation of an active-fixation lead connected to an externalized pacemaker represents a valuable option to increase safety and patient comfort. Yet, evidence remains scarce. We aimed to describe the population receiving prolonged temporary cardiac pacing (PTCP) and their outcomes. Methods: We retrospectively included all consecutive patients, admitted to our hospital from 2016 to 2021, who underwent PTCP. We collected in-hospital and six-month outcomes. Results: Forty-six patients (median age of 73, 63% male) were included, and twenty-nine (63%) had prior heart disease. Indications for PTCP were found: seventeen (37%) potentially reversible high-grade conduction disorders, fourteen (30%) indications for permanent pacemaker but ongoing infection, seven (15%) cardiac implantable electronic device infections requiring extraction in pacing-dependent patients, seven (15%) severe vagal hyperreactivity in prolonged critical care hospitalizations, and one (2%) recurrent sustained ventricular tachycardia requiring overdrive pacing. The median PTCP duration was nine (5–13) days. Ten (22%) patients exhibited at least one complication during hospitalization. Twenty-six (56.5%) patients required definite device implantation (twenty-five pacemakers and one cardioverter-defibrillator) and twenty (43.5%) did not (fifteen PTCP device removal for recovery and five deaths under PTCP). At six months, two (5%) deaths and two (5%) new infections of a definite implanted device occurred, all in patients with initial active infection. Conclusion: The use of prolonged temporary cardiac pacing, with an active -fixation lead connected to an externalized pacemaker, is possible and reasonable; this would allow for the possible recovery or resolution of contraindication for definite device implantation.

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Xia, Zhen, Jianhua Yu, Juxiang Li, Qinmei Xiong, Yanhua Tang, Sujuan Yan, Kui Hong, and Xiaoshu Cheng. "Pacemaker Dysfunction due to a Large Thrombus on Ventricular Lead." Heart Surgery Forum 22, no. 2 (March 11, 2019): E131—E133. http://dx.doi.org/10.1532/hsf.2291.

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Background: Pacemaker lead–related thrombosis is a rare but severe complication in patients with pacing lead implantation in the right ventricle. We present a case with recurrent syncope after single-chamber implantable cardioverter defibrillator (ICD) implantation. Pacing lead–related thrombosis was observed during open-heart surgery. This induced intermittent pacemaker dysfunction and recurrent syncope. Case Presentation: A 67-year-old male patient presented with frequent episodes of syncope and a history of dilated cardiomyopathy and paroxysmal ventricular tachycardia. Normal coronary angiography was found, and therefore a single-chamber ICD was implanted into the right ventricle to prevent cardiac events in 2013. However, he was referred to our hospital because of recurrent syncope 3 to 4 years after ICD implantation. A comprehensive investigation was performed to find out the etiology for the recurrent syncope. Pacing lead thrombosis was finally observed during open-heart surgery, which can introduce intermittent pacemaker dysfunction. After the thrombus was removed and the lead was separated from the posterior leaflet of the tricuspid valve, the ICD functioned normally after reprogramming. Oral anticoagulant was prescribed after discharging. During the 1-year follow-up period, this patient was free of syncope. Conclusions: This case illustrated that pacemaker lead–associated thrombosis should be considered when the cardiac implantable electronic device fails to prevent patients from having cardiac events. Oral anticoagulant might be important for preventing thrombosis among patients with ICD implantation into the right ventricle.

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Leier, Mary. "Advancements in Pacemaker Technology: The Leadless Device." Critical Care Nurse 37, no. 2 (April 1, 2017): 58–65. http://dx.doi.org/10.4037/ccn2017453.

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Leadless pacemakers will most likely be the future of cardiac pacing. Leadless pacing employs a single-chamber system to pace only the right ventricle and is fully self-contained, which eliminates the need for leads. These systems, implanted by using a transcatheter sheath, are indicated for patients who need right ventricular pacing only. These devices enable patients to avoid lead-related complications, from lead fracture to extraction challenges, as well as pocket-related complications such as infection and disfigurement. Leadless pacemakers also are compatible with magnetic resonance imaging and do not require surgical placement, so patients avoid postoperative mobility restrictions. Because this technology will be increasingly used for cardiac internal electronic devices, commonly seen in critical care nursing, nurses must be knowledgeable about the indications for use of a wireless pacemaker, the implantation procedure, postprocedural care, device interrogation, and follow-up. This article discusses leadless pacemakers, clinical indications for their use, key similarities and differences between the current devices being used, key points for nursing care of patients with a leadless device, and the future of this technology.

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Ghossein, Mohammed Ali, Francesco Zanon, Floor Salden, Antonius van Stipdonk, Lina Marcantoni, Elien Engels, Justin Luermans, Sjoerd Westra, Frits Prinzen, and Kevin Vernooy. "Left Ventricular Lead Placement Guided by Reduction in QRS Area." Journal of Clinical Medicine 10, no. 24 (December 17, 2021): 5935. http://dx.doi.org/10.3390/jcm10245935.

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Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.

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Niedermeier, Alexander, Laura Vitali-Serdoz, Theodor Fischlein, Wolfgang Kirste, Veronica Buia, Janusch Walaschek, Harald Rittger, and Dirk Bastian. "Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy." Sensors 21, no. 24 (December 14, 2021): 8346. http://dx.doi.org/10.3390/s21248346.

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Background: ICDs and pacemakers for cardiac resynchronization therapy (CRT) are complex devices with different sensors and automatic algorithms implanted in patients with advanced cardiac diseases. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. Methods: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. Results: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Anesthesia-related events occurred in 69 patients. There was no ADE for non-cardiac surgery and in pacemaker-dependent patients not programmed to an asynchronous pacing mode. Post-operative device interrogation showed significant lead parameter changes in 64/179 patients (36%) requiring reprogramming in 29 cases (16%). Conclusion: The left-ventricular pacing lead represents the most vulnerable system component. Comprehensive pre and post-interventional device interrogation is mandatory to ensure proper system function. The type of ICD function suspension has no impact on each patient’s outcome. Precautionary activity sensor deactivation is not required for non-cardiac interventions. Routine prophylactic device reprogramming to asynchronous pacing appears inessential. Most of the CRT pacemakers do not require surgery-related reprogramming.

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Nguyen, Bich Lien, Alessandro Persi, Eli S. Gang, Fabrizio Fattorini, Alessandra Oliva, Antonio Vitarelli, Nicola Alessandri, Robert J. Siegel, Antonio Ciccaglioni, and Carlo Gaudio. "Three-dimensional binding sites volume assessment during cardiac pacing lead extraction." Clinical Trials and Regulatory Science in Cardiology 7 (July 2015): 1–6. http://dx.doi.org/10.1016/j.ctrsc.2015.08.006.

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Algazzar, Alaa Solaiman, Mohamed Osama Taha, Azza Ali Katta, Asmaa El Abbady, and Heba Abdelmoteleb Lotfy. "Feasibility of left ventricular endocardial lead pacing for cardiac resynchronization therapy." Egyptian Journal of Critical Care Medicine 6, no. 2 (August 2018): 53–55. http://dx.doi.org/10.1016/j.ejccm.2018.05.002.

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Kapa, Suraj, Charles J. Bruce, Paul A. Friedman, and Samuel J. Asirvatham. "Advances in Cardiac Pacing: Beyond the Transvenous Right Ventricular Apical Lead." Cardiovascular Therapeutics 28, no. 6 (November 3, 2010): 369–79. http://dx.doi.org/10.1111/j.1755-5922.2010.00157.x.

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Luetkens, Julian A., Alexander Isaak, Claas P. Naehle, Darius Dabir, and Daniel Thomas. "Extended cardiac magnetic resonance imaging with retained temporary transmyocardial pacing lead." International Journal of Cardiovascular Imaging 35, no. 4 (October 29, 2018): 663–64. http://dx.doi.org/10.1007/s10554-018-1483-1.

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Eduardo Duarte, Carlos, and André Brambilla Sbaraini. "Rational Use of Leads in Artificial Cardiac Pacing." Journal of Cardiac Arrhythmias 32, no. 4 (April 16, 2020): 262–74. http://dx.doi.org/10.24207/jca.v32n4.979_in.

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Introduction: Cardiovascular implantable electronic device (CIEDs) are a proven therapy for the treatment of bradyarrhythmias, prevention of sudden death or heart failure. Since the first transvenous pacemaker implantation more than 60 years ago, technological advances in devices and improvements in surgical techniques have occurred. However, this type of therapy is still associated with significant complications, most of them related to the implantation of transvenous leads. Objective: To present a reflection on how to practice the rational use of lead implantation and propose strategies and alternatives to delay or avoid it, based on the current knowledge in the various fields of artificial cardiac stimulation. Methods: Review of literature that used articles from 1995 to 2019, from several platforms and periodicals. Conclusion: There is an expectation that in the coming years there will be technological and knowledge advances in the field of leadless stimulation, allowing these devices to be incorporated into clinical practice in a routine manner. Currently, if the implantation of ventricular electrodes in cases of sinus node disease with preserved atrioventricular conduction is rationalized, the implantation of atrial electrodes in implantable cardioverter-defibrillators (ICD) without the necessity of antibradicardia stimulation or ventricular electrodes in cases without the necessity of antitachycardia stimulation (ATP) considering the subcutaneous ICD implantation, this article will have fulfilled its role.

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Utsumueva, M. D., N. A. Mironova, O. V. Stukalova, E. M. Gupalo, S. Yu Kashtanova, T. A. Malkina, V. G. Kiktev, and S. P. Golitsyn. "LOCALIZATION OF THE LEFT VENTRICULAR MYOCARDIAL SCARRING AND ITS ELECTRICAL ACTIVATION IN PATIENTS WITH HEART FAILURE AND DIFFERENT RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY." Jounal of arrhythmology 26, no. 3 (February 18, 2020): 5–14. http://dx.doi.org/10.35336/va-2019-3-5-14.

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Introduction. As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12-lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing.Purpose. To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices.Methods. The study included 47 patients (mean age 62.3±8.9 years) with LBBB, QRS duration ≥ 130 ms, left ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR), 12-lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation (ZLA)) were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by > 15% after 6 months of follow-up.Results. CRT was effective in 28 patients (59.5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site - at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0.005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p<0.001), and the pacing zone of late LV activation resulted in the best CRT response (p<0.001). The distance from the LV electrode to the zone of late LV activation was less in the “CRT response” group (33 [20;42] mm vs 83 [55;100] mm, p<0.001). The most beneficial ECG pattern during BV pacing was #2, and #3 was more often observed in the group “CRT non-response”; configuration #1 was intermediate between ECG patterns #2 and #3.Conclusions. A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

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PARVEZ, ZAHID, FARID AHMAD CHAUDHARY, AJMAL HASAN NAZQVI, and Muniza Saeed. "EPICARDIAL PACING." Professional Medical Journal 17, no. 01 (March 10, 2010): 55–58. http://dx.doi.org/10.29309/tpmj/2010.17.01.1980.

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Placement of epicardial wires on the right atrial and right ventricle surfaces is a routine practice in cardiac surgery. These pacingelectrodes are used for invasive pacing of the myocardium for a variety of emergent and elective conditions postoperatively. There is uncertaintyin actual practice about the optimum time for their removal, and practice varies widely between different institutions. Objectives: To determine thetime related efficacy of these pacing electrodes after cardiac surgery, to find out the optimum time of their removal. Period: July 2008 toOctober 2008. Patients & Methods: 47 patients those underwent coronary artery bypass surgery were prospectively enrolled and evaluatedwith standard 12 lead ECG and ventricle pacing threshold immediately after surgery and on the 5t h postoperative day. The patients were dividedinto two subgroups according to their left ventricle ejection fraction ( > 40% verses < 40%). Results: There was significant difference in theeffective pacing threshold in groupl and 2 on immediate post operative period and on day 5. (P = 0.002 and P = 0.02 respectively) The sensingthreshold immediately after operation and on 5t h post operative day also differed significantly (P = 0.009 in group 1 and 0.02 in group 2) Theeffective VVI* pacing was lost in 17 patients (40.5%) on the 5t h post operative day and comparison of effective pacing threshold in the twogroups showed no significant difference during the same period of time (P = NS). "Ventrculo-ventrical inhibition. Conclusions: The epicardialpacing wires have little usefulness after the fifth postoperative day and should be removed by this time. In addition postoperative pacingthreshold was not affected by the decreased left ventricular function.

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Mathew, Dolly, and S. G. Shyam Lakshman. "A case of reversible upper brachial plexopathy following CRT-P implantation." International Journal of Research in Medical Sciences 6, no. 11 (October 25, 2018): 3770. http://dx.doi.org/10.18203/2320-6012.ijrms20184447.

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Brachial plexus injury is a challenging field of hand and upper extremity surgery. Presently available microsurgical techniques and functional gains are rewarding in upper plexus injuries. Cardiac electronic devices implantation rate is the required to manage long-term complications. Cardiac resynchronization therapy (CRT) implantation is a commoner procedure done for severe ischaemic and non ischaemic cardiomyopathy. A 65-year-old male patient underwent CRT device implantation via utilizing his left subclavian vein with a classical incision over the delto pectoral groove, with right ventricular lead on the inter ventricular septum and left ventricular lead into the posterolateral branch of coronary sinus with RA threshold, impedance and amplitude (P) of 1V and 690ohm and 7.8mv respectively. CRT with adjacent nerve structure is carefully selected for vein puncture to minimize the risk of Brachial plexus injury, i.e. pacing lead induces nerve injury. Peripheral nerve injuries are sparsely reported due to procedural as well as indwelling trans venous pacing leads and isolated posterior cord involvement is a rarer presentation hence is reported.

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Lee, Kathy L. "Recent Advances in Pacing and Defibrillation." Asia Pacific Cardiology 3, no. 1 (2011): 74. http://dx.doi.org/10.15420/apc.2011:3:1:74.

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Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

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Gurgu, Andra, Dragos Cozma, and Mihail G. Chelu. "Left bundle branch pacing: the new kid on the block." Romanian Journal of Cardiology 30, no. 4 (January 4, 2021): 571–75. http://dx.doi.org/10.47803/rjc.2020.30.4.571.

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Right ventricular pacing is has deletorius effects due to left ventricular dysynchrony and remodelling and may result in heart failure. Over the last decade, His bundle pacing has emerged as the most physiologic form pacing. However, it has limitations, such as higher capture thresholds, lower R wave amplitudes, atrial oversensing, and increased risk for lead revisions from late threshold increase with subsequent premature battery depletion, which has prevented a wider adoption of this technique in routine clinical practice. Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations. This article summarizes the current status of left bundle branch pacing. Keywords: His bundle pacing, left bundle branch pacing, cardiac resynchronization, therapy heart failure.

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Fink, Thomas, Thomas Eitz, Christian Sohns, Philipp Sommer, and Guram Imnadze. "Left bundle branch pacing as bail out strategy after failed coronary sinus lead placement for cardiac resynchronization: A case report." European Heart Journal - Case Reports, September 19, 2022. http://dx.doi.org/10.1093/ehjcr/ytac375.

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Abstract Introduction Cardiac resynchronisation therapy (CRT) by implantation of an endocardial coronary sinus (CS) pacing lead is an established heart failure therapy. The recent European Society of Cardiology (ESC) guidelines on cardiac pacing and CRT recommend conduction system pacing (CSP) as a potential bail-out therapy in patients with previously unsuccessful CS lead implantation. We present a case in which unsuccessful implantation of a CS pacing and ineffective QRS correction by His-bundle pacing (HBP) was overcome by left bundle branch pacing (LBBP) to achieve cardiac resynchronization. Case summary The patient had to undergo revision of a CS lead for CRT due to rising pacing thresholds and pacing impedance. CS lead implantation was omitted by a stenotic postero-lateral CS branch. HBP did not lead to adequate QRS correction. The patient underwent successful LBB lead implantation as bail out therapy. After LBBP lead implantation electrocardiographic and echocardiographic parameters were evident of effective CRT. Discussion CSP may be an alternative to CS pacing for CRT in heart failure patients, which is endorsed by the current European Guidelines. LBBP may overcome limitations of HBP and provide an alternative to other strategies such as surgical implantation of epicardial left ventricular pacing leads. Further studies are needed to fully clarify the role of LBBP for heart failure treatment.

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Journal articles on the topic 'Cardiac pacing lead'

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