Physiologic Lead Placement with Electroanatomic Mapping: A Case Series

Abstract Aims To examine the feasibility and safety of a novel protocol for low fluoroscopy, electroanatomic mapping (EAM)-guided Cardiac resynchronization therapy with a defibrillator (CRT-D) implantation and using both EnSite NavX (St. Jude Medical, St. Paul, MN, USA) and Carto 3 (Biosense Webster, Irvine, CA, USA) mapping systems. Methods and results Twenty consecutive patients underwent CRT implantation using either a conventional fluoroscopic approach (CFA) or EAM-guided lead placement with Carto 3 and EnSite NavX mapping systems. We compared fluoroscopy and procedural times, radiopaque contrast dose, change in QRS duration pre- and post-procedure, and complications in all patients. Fluoroscopy time was 86% lower in the EAM group compared to the conventional group [mean 37.2 min (CFA) vs. 5.5 min (EAM), P = 0.00003]. There was no significant difference in total procedural time [mean 183 min (CFA) vs. 161 min (EAM), P = 0.33] but radiopaque contrast usage was lower in the EAM group [mean 16 mL (CFA) vs. 4 mL (EAM), P = 0.006]. Likewise, there was no significant change in QRS duration with BiV pacing between the groups [mean −13 (CFA) vs. −25 ms (EAM), P = 0.09]. Conclusion Electroanatomic mapping-guided lead placement using either Carto or ESI NavX mapping systems is a feasible alternative to conventional fluoroscopic methods for CRT-D implantation utilizing the protocol described in this study.

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Bachmann’s bundle potential during atrial lead placement: a case series

Heart Rhythm ◽

10.1016/j.hrthm.2021.11.015 ◽

2021 ◽

Author(s):

Margaret Infeld ◽

Nicole Habel ◽

Kramer Wahlberg ◽

Sean Meagher ◽

Markus Meyer ◽

...

Keyword(s):

Case Series ◽

Lead Placement ◽

Bachmann’S Bundle

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Case Series on Variable Presentation of Ligamentum Flavum Stimulation Following Percutaneous Cylindrical Spinal Cord Stimulator Lead Implants

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/e397 ◽

2014 ◽

Vol 3;17 (3;5) ◽

pp. E397-E403

Author(s):

Dr. Susie S Jang

Keyword(s):

Spinal Cord ◽

Time Course ◽

Ligamentum Flavum ◽

Case Series ◽

Pain Clinic ◽

Spinal Cord Stimulator ◽

Retrospective Case ◽

Background Stimulation ◽

Lead Placement ◽

Time Periods

Background: Stimulation-evoked discomfort secondary to ligamentum flavum stimulation (LFS) is a technological limitation of percutaneous spinal cord stimulator (SCS) lead implants. There is a paucity of literature describing the clinical presentation and time periods at which this side effect may present following insertion of cylindrical lead(s). Objective: To describe a series of 5 patients who presented at varying time periods after SCS lead placement with LFS. Study Design: Retrospective case series. Methods: We performed a chart review of online medical records of patients with symptoms consistent with LFS at an academic interventional pain clinic identified over 7 consecutive years (2006 - 2013). Results: LFS most frequently presented within months of implantation of cylindrical leads. One patient complained of LFS during the temporary trial while another developed LFS after lead revision. All patients were successfully treated when paddle electrodes replaced percutaneous cylindrical leads. Conclusion: LFS may present as a barrier to successful SCS treatment. Clinicians placing percutaneous SCS leads should be aware of the variable time course of LFS presentation. Paddle style electrodes seem to offer an enduring solution to LFS so that patients may continue to benefit from SCS therapy. Key words: Percutaneous electrodes, cylindrical electrode, paddle electrodes, ligamentum flavum stimulation, unwanted stimulation

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Evoked Compound Action Potentials to Guide Lead Placement: A Neuromonitoring Technique Case Series

Neurosurgery ◽

10.1093/neuros/nyz310_350 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Steven M Falowski

Keyword(s):

General Anesthesia ◽

Case Series ◽

Compound Action Potential ◽

Late Response ◽

Implanted Electrodes ◽

Emg Signal ◽

Lead Placement ◽

Potential Estimate ◽

Emg Electrodes ◽

Compound Action

Abstract INTRODUCTION The procedure to place leads on the spinal cord traditionally required patients to be awake for reporting of device-induced paresthesias. Conversely, neuromonitoring using electromyography (EMG) recording determines optimal lead location while the patient is under general anesthesia. These techniques have been compared with regards to safety and efficacy, favoring the use of neuromonitoring1-2We present 7 subjects, incorporating the use of Evoked Compound Action Potential (ECAP) recording from implanted electrodes, using a new SCS system, and comparing the results with EMG recording. METHODS Standard neuromonitoring protocols were employed at 2 institutions Once leads were implanted, stimulation current was increased until the following were observed: ECAP and EMG signal (late response [LR]), and EMG signal on the neuromonitoring EMG electrodes. An x-ray was obtained; postoperative paresthesia testing was performed to assess coverage obtained at different points along the implanted leads. RESULTS Data were obtained from 7 patients, across 2 sites. Onset of EMG signals on implanted electrodes and EMG electrodes correlated. Furthermore, the ratio of current amplitude between EMG onset and ECAP onset (LR: ECAP), on implanted leads, provides a potential estimate of lead laterality and objective lead placement. Whereby a ratio <1 indicates leads are too lateral. This technique was used successfully to place leads under general anesthesia (1 case), without utilizing EMG recording as a dermatomal coverage marker. CONCLUSION Intraoperative recording of ECAPs and EMG signals from implanted leads may facilitate optimized lead placement, without requiring additional equipment and setup. Analysis of ECAP morphology and its relationship with different waveforms could have diagnostic capabilities intraoperatively. This could be correlative with recent results showing the effect of different waveforms on EMG recording.

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Lumbar Dorsal Root Ganglion Stimulation Lead Placement Using an Outside-In Technique in 4 Patients With Failed Back Surgery Syndrome: A Case Series

A & A Practice ◽

10.1213/xaa.0000000000001300 ◽

2020 ◽

Vol 14 (10) ◽

pp. e01300

Author(s):

Kenneth B. Chapman ◽

Sohan Nagrani ◽

Kiran V. Patel ◽

Tariq Yousef ◽

Noud van Helmond

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Case Series ◽

Failed Back Surgery Syndrome ◽

Lead Placement ◽

Failed Back Surgery ◽

Back Surgery ◽

Lumbar Dorsal Root Ganglion

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A Retrospective Case Series of a Novel Spinal Cord Stimulator Trial Technique with Less Displacement and Migration of the Trial Leads

Pain Research and Management ◽

10.1155/2019/1236430 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

N. Shaparin ◽

K. Gritsenko ◽

P. Agrawal ◽

S. Kim ◽

S. Wahezi ◽

...

Keyword(s):

Spinal Cord ◽

Case Series ◽

Small Sample ◽

Spinal Cord Stimulator ◽

Retrospective Case ◽

Thoracic Spinal Cord ◽

Retrospective Case Series ◽

Lead Placement ◽

Spine Pathology ◽

And Migration

Background. Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective. This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design. Retrospective case series. Setting. New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods. A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010–2012). Results. Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations. Small sample size, retrospective case series, and no control group for comparison. Conclusion. This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.

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