scholarly journals Quadripolar Left Ventricular Lead in a Patient with CRT-D does Not Overcome Phrenic Nerve Stimulation

2011 ◽  
Vol 5 ◽  
pp. CMC.S6759 ◽  
Author(s):  
Mariana S. Parahuleva ◽  
Ritvan Chasan ◽  
Nedim Soydan ◽  
Yasser Abdallah ◽  
Christiane Neuhof ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Phrenic Nerve Stimulation ◽  
Ventricular Lead ◽  
Potential Alternative ◽  
Physical Adjustment

Effective cardiac resynchronization therapy (CRT) requires an accurate atrio-biventricular pacing system. The innovative Quartet lead is a quadripolar, over-the-wire left ventricular lead with four electrodes and has recently been designed to provide more options and greater control in pacing vector selection. A lead with multiple pacing electrodes is a potential alternative to physical adjustment of the lead and may help to overcome high thresholds and phrenic nerve stimulation (PNS).

scholarly journals A Case of Useful Short-Spaced Bipolar Pacing of a Left Ventricular Lead to Avoid Phrenic Nerve Stimulation

2016 ◽  
Vol 57 (1) ◽  
pp. 118-120 ◽  
Author(s):  
Tomoyuki Kabutoya ◽  
Yasushi Imai ◽  
Hiroaki Watanabe ◽  
Tomonori Watanabe ◽  
Takahiro Komori ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Phrenic Nerve Stimulation ◽  
Ventricular Lead

scholarly journals Phrenic Nerve Stimulation in a Patient with a Dorsal Column Stimulator

2017 ◽  
pp. 247-249
Author(s):  
Daniel D. DuBose
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Dorsal Column ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Phrenic Nerve Stimulation ◽  
Ventricular Lead ◽  
Before And After ◽  
Muscle Spasms ◽  
Cardiac Resynchronization Therapy Device

We present a case of a 76-year-old female who developed recurrent left-sided muscle spasms resembling hiccups after permanent dorsal column stimulator (DCS) implantation. The patient had a cardiac resynchronization device with defibrillating capabilities (CRT-D) in place, which was interrogated before and after the permanent DCS placement with no interference reported. Due to the timing of the event with the placement of the DCS, it was presumed that the spasms were related to the DCS implantation, and removal of the DCS was considered. However, further evaluation by a cardiology consultant revealed that a lead from her CRT-D was most likely stimulating the phrenic nerve and causing diaphragmatic contractions. The patient was sent to the electrophysiology clinic where the voltage on her left ventricular lead was reduced, and her symptoms resolved completely. Due to the time, risks, and expense of implanting a DCS, it is imperative to consider all other possible causes of diaphragmatic contractions prior to removing a DCS system. Key words: Dorsal column stimulator, cardiac resynchronization therapy device, phrenic nerve stimulation, hiccups, muscle spasms, diaphragmatic contractions, interference

Abstract 14753: A Novel Quadripolar Lead with a Narrow-Spaced Bipole Allows for Effective LV Pacing While Avoiding Phrenic Nerve Stimulation - Attain Performa LV Lead Study Primary Results

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
George H Crossley ◽  
Maurio Biffi ◽  
W. Ben Johnson ◽  
Albert C Lin ◽  
Daniel Gras ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Prospective Clinical Study ◽  
Class Iii ◽  
Phrenic Nerve Stimulation ◽  
Related Complication ◽  
Qrs Duration

Introduction: The Medtronic Attain Performa™ Model 4298 Quadripolar left ventricular (LV) Lead has 4 electrodes, provides 16 different polarities & includes a short bipole (1.3 mm between 2nd & 3rd electrodes). A prospective clinical study was conducted to investigate the safety and effectiveness of this new lead in 20 countries worldwide. Methods: Cardiac resynchronization therapy defibrillator (CRT-D) patients were enrolled & implanted with the Model 4298 LV lead & a Quad CRT-D device. All implanted subjects(SUB) were followed at 1, 3, 6 and every 6 months (M) post-implant. Pacing capture thresholds (PCTs) were measured manually or with automated testing methods. Adverse events (AEs) were reported upon occurrence & reviewed by an independent committee. Events requiring invasive intervention or resulting loss of CRT were considered to be complications. Results: Of 499 SUB (68 + 11 yr, 71% male) who underwent an LV lead implant attempt, 487 (97.6%) had an LV lead implanted, Most (73%) had NYHA Class III or IV symptoms, average LV ejection fraction was 25 ± 7%, QRS duration was 155 ± 24ms & most (71%) had LBBB. There were 20 LV lead related complications in 19 SUB over 6M (LV lead related complication free survival rate = 96%). Phrenic nerve stimulation (PNS) occurred in 31 SUB (6.3%) & resolved with no treatment (N=1) or noninvasive reprogramming (N=29). The average PCT at 6M was 1.1 + 0.7 V at the programmed vector and 93.9% of SUB had a PCT≤ 2.5V. The vast majority (97.7%) of SUB had > 1 additional selectable pacing vector with a PCT ≤ 4V and no PNS. Non-standard pacing polarities (i.e., vectors other than LV1 [LV tip] to right ventricular coil [RVC], LV2 to RVC & LV1 to LV2) were utilized in 56% of SUB. LV1 was not used in the final vector in 46% of SUB. The LV1 to RVC was utilized in 19%, LV1 to LV2 in 18% & the short bipole (LV2 to LV3) in 12%. Conclusions: This large multicenter study demonstrated that implantation of the Model 4298 LV quadripolar lead is associated with a low complication rate and no unanticipated complications. PNS can be readily resolved with reprogramming & that PCT values are low & stable over time. Moreover, At least 1 back-up LV pacing vector was available in the vast majority of SUB. Non-standard vectors, including the short bipole (LV2-LV3) were used in 56% of subjects.

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