Use of a quadripolar left ventricular lead to achieve successful implantation in patients with previous failed attempts at cardiac resynchronization therapy

Aims Problems with implanting a left ventricular (LV) lead during cardiac resynchronization therapy (CRT) procedures are not uncommon and may occur for a variety of reasons including phrenic nerve stimulation (PNS) and high capture thresholds. We aimed to perform successful CRT in patients with prev...

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Bibliographic Details
Published in:Europace (London, England) England), 2011-07, Vol.13 (7), p.992-996
Main Authors: Shetty, Anoop K., Duckett, Simon G., Bostock, Julian, Rosenthal, Eric, Rinaldi, C. Aldo
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiac Resynchronization Therapy - methods
Cardiac Resynchronization Therapy Devices
Cardiomyopathies - physiopathology
Cardiomyopathies - therapy
Clinical Research
Coronary Sinus - physiopathology
Electrodes, Implanted
Female
Heart Ventricles - physiopathology
Humans
Male
Middle Aged
Phrenic Nerve - physiopathology
Treatment Failure
Treatment Outcome
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Summary:Aims Problems with implanting a left ventricular (LV) lead during cardiac resynchronization therapy (CRT) procedures are not uncommon and may occur for a variety of reasons including phrenic nerve stimulation (PNS) and high capture thresholds. We aimed to perform successful CRT in patients with previous LV lead problems using the multiple pacing configurations available with the St Jude Quartet model 1458Q quadripolar LV lead to overcome PNS or high capture thresholds. Methods and results Four patients with previous failed attempts at LV lead implantation underwent a further attempt at CRT using a Quartet lead. In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus. Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome. Satisfactory lead parameters were seen at implant, pre-discharge, and at short-term follow-up (8.5 ± 5 weeks). Conclusion The Quartet lead allows 10 different pacing vectors to be used and may overcome common pacing problems because of the multiple pacing configurations available. Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/eur032