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Long-term experience with a preshaped left ventricular pacing lead
Jacky Ollitrault1, Philippe Ritter, Philippe Mabo
1Hôpital Européen Georges Pompidou 20, rue Leblanc, 75908 Paris, France. j.ollitrault@free.fr
Insights
This study shows a new left ventricular (LV) pacing lead is successfully implanted in most patients with advanced heart failure. The lead demonstrates stable electrical properties, suggesting long-term pacemaker performance and durability.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Advanced dilated cardiomyopathy often requires cardiac resynchronization therapy (CRT).
- Effective CRT depends on reliable left ventricular (LV) lead performance.
- Long-term data on new LV pacing lead designs are crucial for clinical adoption.
Purpose of the Study:
- To evaluate the long-term performance and safety of a novel LV pacing lead.
- To assess the electrical characteristics of the lead throughout the follow-up period.
- To determine the feasibility of implantation in patients with advanced heart failure.
Main Methods:
- A prospective study involving 62 patients with NYHA Class III/IV heart failure and prolonged QRS duration.
- Implantation of a new LV pacing lead with either a triple or dual chamber pacemaker.
- Clinical evaluations and pacemaker interrogations at multiple time points up to 7 months, with 2-year follow-up for some patients.
- Measurement of R wave amplitude, pacing threshold, and pacing impedance.
Main Results:
- Successful implantation of the LV lead in 86% of patients.
- Mean R wave amplitude at implant was 15 ± 7 mV.
- Pacing threshold increased from 0.73 ± 0.54 V at implant to 1.57 ± 0.60 V at 7 months (P < 0.001).
- Mean pacing impedance remained high at 1054 ± 254 Ω, indicating low current drain.
Conclusions:
- The novel LV pacing lead is successfully implanted in a high percentage of patients.
- Stable and favorable electrical parameters, including high impedance, suggest good lead longevity.
- The lead's performance supports its use in cardiac resynchronization therapy for heart failure patients.
Abstract:
This study describes a long-term experience with a new LV pacing lead. The study population consisted of 62 patients (85% men, 71 +/- 10 years old) with advanced dilated cardiomyopathy, in NYHA Class III or IV despite optimal drug therapy, and a QRS duration > 150 ms. Patients in sinus rhythm were implanted with a triple chamber pacemaker to maintain atrioventricular synchrony. A dual chamber pacemaker was implanted in patients in atrial fibrillation for biventricular pacing only. A clinical evaluation and interrogation of the resynchronization pacemaker were performed at implant, at 1 week (W1), one (M1), four (M4), and seven (M7) months after implantation. A longer follow-up (2 years) is available for patients implanted at the authors institution. LV measurements were pacing threshold at 0.5-ms pulse duration and pacing impedance. R wave amplitude (mV) was measured at the time of implantation only. The system was successfully implanted in 86% of patients with the latest design of the lead. Mean R wave amplitude at implant was 15 +/- 7 mV and mean pacing impedance was 1054 +/- 254 omega. Between implant (n = 38) and M7 (n = 15), pacing threshold rose from 0.73 +/- 0.54 to 1.57 +/- 0.60 V (P < 0.001). In conclusion, the situs lead was successfully implanted in a high percentage of patients. In addition, low pacing threshold and high impedance measured during follow-up are consistent with a low pacing current drain, ensuring a durable pulse generator longevity.