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The novel active fixation coronary sinus lead: efficacy and safety of transvenous extraction procedure
Luca Bontempi1, Francesca Vassanelli2, Najat Ashofair1
1Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Brescia, Italy.
Insights
Lead stability is a challenge in cardiac resynchronization therapy (CRT). A new active fixation left ventricular lead was successfully and safely extracted, demonstrating a viable solution for lead management in CRT patients.
Area of Science:
- Cardiology
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes.
- Complications with coronary sinus (CS) leads, such as dislodgement and high pacing thresholds, negatively impact patient quality of life and healthcare costs.
- Lead stability remains a significant unmet need in CRT procedures.
Observation:
- A novel active fixation left ventricular (LV) lead (Medtronic 20066 Attain Stability®) features a small side helix for secure vein placement.
- This study reports the first human experience with the extraction of this specific active fixation LV lead.
Findings:
- The extraction of the novel active fixation LV lead was performed safely and effectively.
- No dissection or damage to the CS was observed during or after lead removal.
- A rotation maneuver combined with moderate traction proved effective for lead extraction.
Implications:
- This extraction technique offers a safe and effective solution for managing novel active fixation LV leads.
- Successful lead extraction contributes to improved patient outcomes and potentially reduced healthcare burdens associated with CRT complications.
- Further research should validate these findings in larger patient cohorts.
Aims:
Benefits of cardiac resynchronization therapy (CRT) are well known for heart failure; however, some patients might experience complications related to the coronary sinus (CS) lead (high pacing threshold, phrenic nerve stimulation, and dislodgment) with unfavourable impact on quality of life, costs, and management. Lead stability is one of the most common unmet needs for CRT procedures.
Methods And Results:
Recently, new model Medtronic 20066 Attain Stability(®) (Maastricht, The Netherlands) active fixation LV lead has been released, to overcome this issue. The lead has a small side helix of 0.20 mm (0.008 in.) that allows for secure placement of the lead within the vein at the desired location. We report our first experience with the extraction of this novel active fixation left ventricular lead.
Conclusion:
In our case, to our knowledge the first reported in humans, the extraction of this new model of active fixation lead was proved to be a safe and effective procedure at 8 months after implantation. Indeed, under angiographic and fluoroscopic check, there was no documented dissection or damage to the CS during and after removal of the lead. The rotation manoeuvre was effective when combined with moderate traction of the lead itself.
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