Michael V Orlov1, David Casavant2, Ioannis Koulouridis3, Mikhail Maslov3, Aharon Erez3, Amy Hicks4, Ahad Jahangir4, Joe Aoun3, John V Wylie3. 1. Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts. Electronic address: Michael.Orlov@steward.org. 2. Boston Scientific, Marlborough, Massachusetts. 3. Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts. 4. Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts.
Abstract
BACKGROUND: The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. OBJECTIVE: The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS: Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS: HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 ± 43 minutes vs 104 ± 43 minutes and 9.6 ± 5.2 minutes vs 8.3 ± 5.0 minutes, respectively (both P = NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 ± 1.5 V vs 1.5 ± 1.2 V; P = .02) and remained stable at 8.4 ± 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION: Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.
BACKGROUND: The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. OBJECTIVE: The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS: Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS: HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 ± 43 minutes vs 104 ± 43 minutes and 9.6 ± 5.2 minutes vs 8.3 ± 5.0 minutes, respectively (both P = NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 ± 1.5 V vs 1.5 ± 1.2 V; P = .02) and remained stable at 8.4 ± 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION: Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.
Authors: Andres Di Leoni Ferrari; Guilherme Ferreira Gazzoni; Luis Manuel Ley Domingues; Jessica Caroline Feltrin Willes; Gustavo Chiari Cabral; Flavio Vinicius Costa Ferreira; Laura Orlandini Lodi; Gustavo Reis Journal: Arq Bras Cardiol Date: 2022-02 Impact factor: 2.000
Authors: F Daniëls; A Adiyaman; K M Aarnink; F J Oosterwerff; J R A Verbakel; A Ghani; J J J Smit; M A Kanters; P P H M Delnoy; A Elvan Journal: Clin Res Cardiol Date: 2022-06-18 Impact factor: 6.138