BACKGROUND: Ventricular sensing in transvenous cardiac implantable electronic devices (CIEDs) occurs conventionally from the right ventricular (RV) channel, though it evolved from epicardial sensing both in pacemakers and implantable cardioverter-defibrillators (ICDs). HYPOTHESIS: The objective of this study was to observe the reliability of left ventricular (LV) sensing by transvenous leads placed in coronary veins. METHODS: LV leads were used for sensing and arrhythmia detection in clinical situations where placement of an RV lead across the tricuspid valve was either not preferred or not feasible, or RV signal was unsuitable for arrhythmia detection, or in the event of sensing failure of an RV lead under advisory in cardiac resynchronization therapy defibrillator (CRTD) recipients. RESULTS: Thirty-seven patients had an IS-1 LV lead connected to the RV port of CIEDs (17 pacemakers, 5 cardiac resynchronization therapy pacemaker [CRTP], 2 ICDs, and 13 CRTDs). Along a median 41 (25-67) months follow-up, lead performance remained stable; there were neither undersensing nor oversensing of non-cardiac signals. VT/VF were correctly detected and terminated by ATP and shocks (one and three patients, respectively); no inappropriate arrhythmia detection. Device reprogramming occurred in four CRTD recipients because of transient counting the QRS (short intervals) when paced in LV-only, and in two with T-wave oversensing. CONCLUSIONS: Ventricular sensing by an LV lead is feasible in transvenous devices. Sensing programmability is an unmet need: to fix RV lead sensing issues in cardiac resynchronization therapy (CRT) recipients at no risk of infection (no pocket opening); to avoid interaction with the tricuspid valve; to avoid lead redundancy in the vasculature. Moreover, it will be mandatory owing to the loss of lead interchangeability due to the adoption of DF-4 and quadripolar leads.
BACKGROUND: Ventricular sensing in transvenous cardiac implantable electronic devices (CIEDs) occurs conventionally from the right ventricular (RV) channel, though it evolved from epicardial sensing both in pacemakers and implantable cardioverter-defibrillators (ICDs). HYPOTHESIS: The objective of this study was to observe the reliability of left ventricular (LV) sensing by transvenous leads placed in coronary veins. METHODS: LV leads were used for sensing and arrhythmia detection in clinical situations where placement of an RV lead across the tricuspid valve was either not preferred or not feasible, or RV signal was unsuitable for arrhythmia detection, or in the event of sensing failure of an RV lead under advisory in cardiac resynchronization therapy defibrillator (CRTD) recipients. RESULTS: Thirty-seven patients had an IS-1 LV lead connected to the RV port of CIEDs (17 pacemakers, 5 cardiac resynchronization therapy pacemaker [CRTP], 2 ICDs, and 13 CRTDs). Along a median 41 (25-67) months follow-up, lead performance remained stable; there were neither undersensing nor oversensing of non-cardiac signals. VT/VF were correctly detected and terminated by ATP and shocks (one and three patients, respectively); no inappropriate arrhythmia detection. Device reprogramming occurred in four CRTD recipients because of transient counting the QRS (short intervals) when paced in LV-only, and in two with T-wave oversensing. CONCLUSIONS: Ventricular sensing by an LV lead is feasible in transvenous devices. Sensing programmability is an unmet need: to fix RV lead sensing issues in cardiac resynchronization therapy (CRT) recipients at no risk of infection (no pocket opening); to avoid interaction with the tricuspid valve; to avoid lead redundancy in the vasculature. Moreover, it will be mandatory owing to the loss of lead interchangeability due to the adoption of DF-4 and quadripolar leads.
Authors: C Jan Willem Borleffs; Joep Thijssen; Mihály K de Bie; Johannes B van Rees; Guido H van Welsenes; Lieselot van Erven; Jeroen J Bax; Suzanne C Cannegieter; Martin J Schalij Journal: Pacing Clin Electrophysiol Date: 2010-04-27 Impact factor: 1.976
Authors: Suneet Mittal; Richard E Shaw; Kimberly Michel; Rachel Palekar; Aysha Arshad; Dan Musat; Mark Preminger; Tina Sichrovsky; Jonathan S Steinberg Journal: Heart Rhythm Date: 2013-12-10 Impact factor: 6.343
Authors: Ilan Hay; Vojtech Melenovsky; Barry J Fetics; Daniel P Judge; Andrew Kramer; Julio Spinelli; Craig Reister; David A Kass; Ronald D Berger Journal: Circulation Date: 2004-11-22 Impact factor: 29.690
Authors: Raymond Yee; Fredrik Gadler; Azlan Hussin; Razali Bin Omar; Yaariv Khaykin; Atul Verma; Mark Lazeroms; Douglas S Hine; Kyle R Marquard Journal: Heart Rhythm Date: 2014-05-04 Impact factor: 6.343