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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Abstract
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CLEAR FILTERS
Initial experience with a new quadripolar active fixation left ventricular lead for cardiac resynchronization therapy
Session:
Painel 5 - Arritmologia 6
Speaker:
Hipólito Reis
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
António Hipólito Reis; Maria Trêpa; Marta Fontes Oliveira; Maria Monteiro Sousa; Severo Torres
Abstract
<p>Introduction</p> <p>Cardiac resynchronization therapy (CRT) is a highly effective treatment option for selected patients with heart failure, cardiac dyssynchrony and reduced ejection fraction. One of the predictors of response to CRT is LV lead placement. Medtronic® has developed a new LV lead with active fixation, the Attain Stability Quad™ Active Fixation LV Lead (Model 4798), which intends to improve lead positioning and stability. This new design might allow the operator to choose the exact location of the lead in the vein, which is particularly useful for pacing in basal segments and in patients larger veins and/or complex anatomies. Here we report our initial experience with this new active fixation LV lead, regarding to procedural aspects, pacing parameters performance and stability.</p> <p>Methods</p> <p>Prospective study of consecutive 32 patients eligible for CRT who were implanted the new LV lead (Model 4798). A single, highly experienced operator performed all procedures. Lead fixation success was confirmed by the <em>push and pull test</em>. Lead impedance, sensing and threshold were analysed immediately after implantation and after a median follow-up of 3 months.</p> <p>Results</p> <p>Patients mean age was 74±13 years-old and 53% were female. 69% had non-ischemic cardiomyopathy, median LV ejection fraction was 29±7% and the median QRS duration was 163±25ms (91% had complete left bundle branch block). 22% (n=7) of the procedures were upgrades from pacemaker or implantable cardiac defibrillator to CRT.</p> <p>Venous access in first implantations (n=25; 78%) was achieved exclusively through the cephalic vein in 60% of patients: 13 patients received 3 leads (LV, RV, RA) and 2 patients received 2 leads (LV, RV). All leads were implanted through the subclavian vein when the procedure was an upgrade in patients with a previous cardiac device. The LV lead was placed in the lateral or in the postero-lateral tributary veins of the coronary sinus in 53% and 19%, respectively.</p> <p>31 of 32 patients were successfully implanted at first attempt (success rate: 97%). 1 patient had a small vein dissection but was successful implanted at a 2<sup>nd</sup> procedure. There were no other complications. The electrode was robust and easy to handle with no technical issues registered. Peri-procedural LV thresholds and impedance were 1.2±0.74 V and 909±331 ohm respectively. At follow-up, LV threshold was 0.94±0.6V and impedance was 600±133 ohm.</p> <p>During follow-up (median: 342±178 days), we observed one lead displacement and one abnormal elevation in LV threshold. Both events happened early after implantation and patients were re-operated with success using the same lead. Lead performance remained stable in all other patients.</p> <p>Conclusion</p> <p>Implantation of this new active fixation LV lead was safe and feasible with a success rate of 97%. Follow-up revealed good lead performance.</p>
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