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Left atrial- and left ventricular-based single lead DDD pacing.
C C de Cock1, C M van Campen, D H Vos
1Department of Cardiology, Academic Hospital VU, De Boelelaan, Amsterdam.
Pacing and Clinical Electrophysiology : PACE
|May 9, 2001
Summary
Single lead pacing in the left atrium or ventricle via the coronary sinus is feasible. This approach shows potential for improved cardiac function, though further research is needed to enhance lead stability and success rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Right ventricular apex pacing is standard but may not be optimal for all patients.
- Left ventricular (LV) or biventricular pacing via coronary sinus tributaries can improve outcomes in heart failure.
- Left atrial (LA) stimulation has also been achieved using the proximal coronary sinus.
Purpose of the Study:
- To assess the feasibility and pacing characteristics of temporary LA- and LV-based pacing using a conventional single-pass lead.
- To evaluate lead stability and stimulation parameters in the coronary sinus.
Main Methods:
- A conventional single-pass lead was advanced into distal lateral or posterolateral branches of the coronary sinus.
- Stable lead positioning was achieved in 13 of 21 attempts.
- Overlapping biphasic (OLBI) stimulation was used to measure pacing thresholds and sensing values.
Main Results:
- Successful stable lead positioning was achieved in 13/21 patients.
- Pacing thresholds were 2.3 ± 0.6 V for LA and 2.5 ± 0.5 V for LV.
- Sensing values for P waves (4.1 ± 0.7 mV) and R waves (9.7 ± 3.9 mV) were acceptable.
- A strong correlation (r=0.92, P<0.0001) was found between coronary sinus diameter and atrial pacing threshold.
Conclusions:
- Single lead LA- and LV-based pacing via the coronary sinus is feasible.
- Further development is required to improve the success rate for stable stimulation at these sites.