scholarly journals Aortic Perforation by Active-Fixation Atrial Pacing Lead: An Unusual but Serious Complication

2014 ◽  
Vol 41 (3) ◽  
pp. 327-328 ◽  
Author(s):  
Andrea Di Marco ◽  
Elaine Nuñez ◽  
Karina Osorio ◽  
Paolo Dallaglio ◽  
Ignasi Anguera ◽  
...  
Keyword(s):  
Aortic Root ◽  
Postoperative Recovery ◽  
Right Atrial ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Atrial Pacing ◽  
Complete Control ◽  
First Case ◽  
Pacing Lead ◽  
Prolene Suture

Perforation of a cardiac chamber is an infrequent but serious sequela of pacemaker lead implantation. An even rarer event is the perforation of the aorta by a protruding right atrial wire. We present here the first case in the medical literature of aortic perforation as a sequela to the implantation of a cardiac resynchronization therapy defibrillator. The patient was a 54-year-old man with idiopathic dilated cardiomyopathy who underwent the implantation of a defibrillator, with no apparent sequelae. Six hours after the procedure, he experienced cardiac tamponade and required urgent open-chest surgery. The pericardial effusion was found to be caused by mechanical friction of a protruding right atrial wire on the aortic root. The aortic root and the atrial wall were both repaired with Prolene suture, which achieved complete control of the bleeding. There was no need to reposition the atrial wire. The patient had a good postoperative recovery.

scholarly journals First experience in quadripolar active fixation coronary sinus lead extraction: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Elhosseyn Guella ◽  
Michael Brack ◽  
Khalid Abozguia ◽  
Christopher John Cassidy
Keyword(s):  
Coronary Sinus ◽  
Atrioventricular Node ◽  
Right Atrial ◽  
Cardiac Resynchronization ◽  
Lead Extraction ◽  
Active Fixation ◽  
First Case ◽  
Potential Difficulty ◽  
History Of ◽  
The Right

Abstract Background The Attain Stability Quadripolar 4798 lead is a relatively new quadripolar active fixation coronary sinus (CS) lead. No cases of extraction of a chronically implanted 4798 lead have been published to date. Case summary A 52-year-old man with a history of previous cardiac resynchronization therapy pacemaker (CRT-P) insertion and atrioventricular node ablation presented to our institution with a pocket infection 69 weeks after implantation. Directed intravenous antibiotic therapy was commenced and an extraction was performed the following day. Extraction of the right atrial and right ventricular leads was simple and achieved with gentle manual traction. Extraction of the CS lead was more difficult. Significant traction was required due to the formation of adhesions inside the CS but extraction of the lead was eventually successful without complication. Specialized extraction equipment was not required. A new contralateral CRT-P device was implanted, and the patient was discharged home. He remains well at 3 months of follow-up. Discussion We present the first case of extraction of a chronically implanted active fixation Attain Stability Quadripolar lead. Our experience demonstrates that this has been performed successfully without specialist tools and with preservation of the CS branch. Significant adhesion was noted at the site of active fixation, however. Potential difficulty with this lead’s extraction should therefore be considered when contemplating its use.

scholarly journals Heart rhythm model for the simulation of electric fields in transesophageal atrial pacing and cardiac resynchronization therapy

2018 ◽  
Vol 4 (1) ◽  
pp. 443-445
Author(s):  
Kerem Göküs ◽  
Matthias Heinke ◽  
Johannes Hörth
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Right Atrial ◽  
Cardiac Resynchronization ◽  
Electrode Position ◽  
Atrial Pacing ◽  
Far Field ◽  
Resynchronization Therapy ◽  
Rv Pacing

AbstractElectric field of biventricular (BV) pacing, left ventricular (LV) electrode position and electrical interventricular desynchronization are important parameters for successful cardiac resynchronization therapy (CRT) in patients with heart failure, sinus rhythm and reduced LV ejection fraction. The aim of the study was to evaluate electric pacing field of transesophageal left atrial (LA) pacing and BV pacing with 3D heart rhythm simulation. Bipolar right atrial (RA), right ventricular (RV), LV electrodes and multipolar hemispherical esophageal LA electrodes were modeled with CST (Computer Simulation Technology, Darmstadt). Electric pacing field were simulated with bipolar RA and RV pacing with Solid S (Biotronik) electrode, bipolar LV pacing with Attain 4194 (Medtronic) electrode and bipolar LA pacing with TO8 (Osypka) esophageal electrode. 3D heart rhythm model with esophagus allowed electric pacing field simulation of 4-chamber pacing with bipolar intracardiac RA, RV, LV pacing and bipolar transesophageal LA pacing. The pacing amplitudes were 3V RA pacing amplitude, 50V LA pacing amplitude, 1.5V RV pacing amplitude and 3V LV pacing amplitude with 0.5ms pacing pulse duration. The atrioventricular delay between RA pacing and BV pacing was 140ms atrioventricular pacing delay and simultaneous RV and LV pacing. Electric pacing fields were simulated during the different pacing modes AAI, VVI, DDD and DDD0V. The intracardiac far-field pacing potentials were evaluated with intracardiac electrodes and a distance of 1mm from the electrodes with RA electrode 1.104V, RV electrode 0.703V and LV electrode 1.32V. The transesophageal far-field pacing potential was evaluated with transesophageal electrode and a distance of 10mm from the elelctrode with LA electrode 6.076V. Heart rhythm model simulation with esophagus allows evaluation of electric pacing fields in AAI, VVI, DDD, DDD0V and DDD0D pacing modes. Electric pacing field of RA, RV and LV pacing in combination with LA pacing may additional useful pacing mode in CRT non-responders.

Video-Assisted Implantation of a Left Ventricular Lead and Intrathoracic Tunneling to a Right-Sided CRT-D Device

2011 ◽  
Vol 6 (5) ◽  
pp. 341-343
Author(s):  
Thijs Stoker ◽  
Theo J. Klinkenberg ◽  
Alexander H. Maass ◽  
Massimo A. Mariani
Keyword(s):  
Left Ventricular ◽  
Pleural Space ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Video Assisted ◽  
Ventricular Lead ◽  
Pacing Lead ◽  
Left Ventricular Pacing ◽  
The Right

We describe two cases in which a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy had to be placed on the right side due to unsuitability of the left subclavian vein. Endocardial implantation of a left ventricular lead through the coronary sinus was previously attempted but was unsuccessful. Implantation of the epicardial left ventricular pacing lead was performed through video-assisted thoracic surgery on the left side. The connector end of the left ventricular pacing lead was tunnelized through the anterior mediastinum into the right pleural space. The right-sided pocket was then opened. A tunnel was created from the pocket to the thoracic wall, and the pleural space was entered over the second rib. The lead was retrieved from the right pleural space and connected with the Cardiac resynchronization therapy-device (CRT-D). Both procedures and postoperative periods were uneventful. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery is feasible and safe. It provides an alternative to subcutaneous tunneling.

Elevated plasma endothelin-1 levels in coronary sinus during rapid right atrial pacing in patients with slow coronary flow

2004 ◽  
Vol 97 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Hasan Pekdemir ◽  
Gurbuz Polat ◽  
V.Gökhan Cin ◽  
Ahmet Çamsari ◽  
Dilek Cicek ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Coronary Flow ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Elevated Plasma ◽  
Slow Coronary Flow ◽  
Endothelin 1
Sign in / Sign up

Export Citation Format

Share Document