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Implantation of Active Fixation Leads in Coronary Veins for Left Ventricular Stimulation: Report of Five Cases
Author(s) -
HANSKY BERT,
VOGT JUERGEN,
GUELDNER HOLGER,
SCHULTEEISTRUP SEBASTIAN,
LAMP BARBARA,
HEINTZE JOHANNES,
HORSTKOTTE DIETER,
KOERFER REINER
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00578.x
Subject(s) - medicine , coronary vein , catheter , fixation (population genetics) , cardiology , surgery , ventricular pacing , coronary sinus , heart failure , population , environmental health
Background: Securing transvenous left ventricular (LV) pacing leads without an active fixation mechanism in proximal coronary vein (CV) segments is usually challenging and frequently impossible. We investigated how active fixation leads can be safely implanted in this location, how to avoid perforating the free wall of the CV, and how to recognize and respond to perforations.Materials and Methods: In five patients with no alternative to LV pacing from proximal CV segments, 4 Fr SelectSecure (Medtronic, Minneapolis, MN, USA) leads, which have a fixed helix, were implanted through a modified 6 Fr guide catheter with a pre‐shaped tip (Launcher, Medtronic).Results: Active fixation leads were successfully implanted in proximal CVs in five patients. There were no complications. Acute and chronic pacing thresholds were comparable to those of conventional CV leads. The pre‐shaped guide catheter tip remains in close proximity to the myocardial aspect of the CV, directing the lead helix toward a safe implantation site.Conclusions: If only proximal CV pacing sites are available, 4 Fr SelectSecure leads can be safely implanted through a modified Launcher guide catheter, avoiding more invasive implantation techniques. Other than venous stenting or implantation of leads with retractable tines, SelectSecure leads are expected to remain extractable.