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Left ventricular lead implantation at a phrenic stimulation site is safe and effective.
MedLine Citation:
PMID:  21242156     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims Phrenic stimulation (PS) is a major limiting factor for both left ventricular (LV) lead placement and cardiac resynchronization therapy (CRT) delivery. We have developed a protocol allowing for LV lead implantation at a PS site based on specific criteria regarding phrenic and LV acute capture thresholds. The present study examined long-term outcomes in patients treated using this protocol. Methods and results A total of 211 consecutive patients underwent CRT device implantation. The procedure was successful in 201 patients. Leads were implanted at a PS site in 27 patients (PS patients) and a non-PS site in 174 patients (non-PS patients). Left ventricular leads were placed at a PS site only on the following conditions: no PS at ≤3.5 V/0.5 ms, LV threshold ≤1.5 V, and a PS/LV threshold ratio >4. The mean PS threshold decreased (5.1 ± 1.6 vs. 2.8 ± 1.6 V, P< 0.001) and the mean LV threshold remained stable (1.0 ± 0.7 vs. 0.9 ± 0.8 V, P= 0.6) in PS patients over the 16 ± 9 month follow-up. Only one PS patient experienced non-reprogrammable PS and required a re-operation. Seven PS patients required very low LV channel output programming without the usual safety margin of twice the LV threshold amplitude or three times the pulse width. However, 100% LV capture was shown in those patients during daily activity. Non-reprogrammable PS occurred in 2 of the 174 non-PS patients. Conclusion Our strategy for LV lead implantation at a PS site was found to result in long-term safe and effective outcomes.
Authors:
Marek Jastrzebski; Bogumila Bacior; Wiktoria Wojciechowska; Danuta Czarnecka
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-17
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1First Department of Cardiology and Hypertension, University Hospital, ul. Kopernika 17, 31-501 Krakow, Poland.
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