Implantation Techniques and Chronic Lead Parameters of Biventricular Pacing Dual-Chamber Defibrillators

• Published in: Journal of cardiovascular electrophysiology 2002-10, Vol.13 (10), p.964-970
• Main Authors: DAOUD, EMILE G., KALBFLEISCH, STEVEN J., HUMMEL, JOHN D., WEISS, RAUL, AUGUSTINI, RALPH S., DUFF, STEVEN B., POLSINELLI, GEORGIA, CASTOR, JOHN, META, TEJAS
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Pacing, Artificial; Coronary Vessels - physiopathology; Coronary Vessels - surgery; defibrillator; Defibrillators, Implantable; Electrocardiography; Female; Follow-Up Studies; heart failure; Heart Failure - complications; Heart Failure - mortality; Heart Failure - therapy; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; lead; left ventricle; Length of Stay; Male; Middle Aged; Multivariate Analysis; pacemaker; Postoperative Complications - etiology; Postoperative Complications - mortality; resynchronization; Survival Analysis; Thoracotomy; Time Factors; Treatment Outcome; United States
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1046/j.1540-8167.2002.00964.x

Biventricular Pacing. Introduction: The aim of this study is to describe implantation techniques and lead performance for biventricular pacing, dual‐chamber implantable cardioverter defibrillators (ICDs). Methods and Results: A dual‐chamber ICD with biventricular pacing was implanted in 87 patients with congestive heart failure (ejection fraction: 0.21 ± 0.09), prolonged QRS duration (161 ± 22 msec), and an indication for ICD therapy. Left ventricular pacing was achieved with a thoracotomy approach (n = 21) or a nonthoracotomy approach (n = 66). With a thoracotomy, biventricular devices were implanted successfully in all patients. During follow‐up (17 ± 11 months), 9 patients died (43%), 2 underwent transplantation, and 2 required left ventricular lead revision. At last follow‐up, biventricular sensing and capture threshold were 11 ± 5 mV and 1.5 ± 0.8 V, respectively. For nonthoracotomy procedures, two types of coronary sinus (CS) leads were implanted: an over‐the‐wire lead (n = 45) and a shaped lead (n = 21). The rate of successful implantation (overall: 89%) (over‐the‐wire 93% vs shaped 81%; P = 0.1) and durations for CS lead placement (66 ± 50 vs 58 ± 34 min, P = 0.6) and the procedure (133 ± 58 vs 129 ± 33 min, P = 0.8) were not different between the two CS leads. During follow‐up (11 ± 9 months), 9 patients died (14%), and the shaped CS lead dislodged in 3 patients (3 shaped vs 0 over‐the‐wire, P = 0.01). At last follow‐up, biventricular sensing and capture threshold were 10 ± 4 mV and 1.8 ± 0.7 V, respectively, and there was no difference between over‐the‐wire and shaped leads. By multivariate analysis, mortality was associated with absence of spironolactone therapy but not procedural features. Conclusion: Nonthoracotomy CS lead implantation is feasible, with a success rate of about 90% and few adverse events. For the remaining 10%, a thoracotomy approach can be completed safely in these ill patients without increased risk for death.