Effective nonapical left ventricular pacing with quadripolar leads for cardiac resynchronization therapy

Background: Current guidelines recommend avoiding apical left ventricular (LV) pacing for cardiac resynchronization therapy (CRT). Aims: We investigated the feasibility of nonapical pacing with the current quadripolar LV lead technology. Methods: We analyzed consecutive patients who received CRT with an LV quadripolar lead. The post­­implantation position of each electrode of the LV lead was designated as basal, mid, or apical. The pacing capture threshold (PCT) and phrenic nerve stimulation (PNS) threshold were assessed for each electrode. Results: We enrolled 168 patients. A total of 8 CRT defibrillators were from Biotronik (with Sentus OTW QP leads), 98 were from Boston Scientific (with 21 Acuity X4 Spiral and 77 Acuity X4 Straight leads), and 62 from St. Jude Medical (with Quartet leads). The median (interquartile range) number of electrodes at nonapical segments per patient was 3 (1–4) with Biotronik Sentus leads, 4 (3–4) with spiral ­design Boston Scientific leads, 4 (3–4) with straight Boston Scientific leads, and 3 (3–4) with St. Jude Medical Quartet leads (P = 0.045). Three patients (38%) with Biotronik Sentus leads, 21 (100%) with spiral ­design Boston Scientific leads, 69 (90%) with straight ­design Boston Scientific leads, and 49 (79%) with St. Jude Medical Quartet leads (P < 0.001) had at least 1 electrode located at nonapical segments linked with a PNS ­PCT safety margin of more than 2 V. During the 6­month follow ­up, PNS was detected in 4 patients and was eliminated with reprogramming. No significant changes in PCT were detected during follow ­up. Conclusions: Quadripolar leads allowed nonapical pacing with acceptable electrical parameters in the majority of CRT recipients, although differences were found among the currently available devices

Cardiac Implantable Electronic Devices Breakthrough: Are We Ready to Face the Future?

Since its inception cardiac electrical therapy has evolved, with transvenous pacemakers (PMs) and implantable cardiac defibrillators (ICDs) providing significant benefits in terms of improved quality of life and reducing mortality in patients with cardiac conduction disturbances and/or requiring protection against ventricular arrhythmias [...

Cryoablation of para-Hisian and mid-septal accessory pathways: long-term outcome of a specific cryoablation protocol

missin

Cryoablation of para-Hisian and mid-septal accessory pathways: long-term outcome of a specific cryoablation protocol

missin

Cryoablation of para-Hisian and mid-septal accessory pathways: long-term outcome of a specific cryoablation protocol

missin

Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: A case series

Transvenous lead extraction is the standard therapy for cardiac device-related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary

Cryoablation of para-Hisian and mid-septal accessory pathways: long-term outcomes of a specific stepwise cryoablation protocol

Background: Although cryoablation (CA) of septally located accessory pathways (APs) is an established treatment for Wolff-Parkinson-White syndrome, its major limitation is the lack of data regarding long-term follow-up (FU). The present study sought to investigate long-term outcomes of a specific CA protocol targeting para-Hisian (P-H) and mid-septal (M-S) APs. Methods: 26 patients who previously underwent CA of PH or MS APs from 2004 to 2014, were prospectively considered to receive a follow-up (FU) during 2021. All subjects received an outpatient control visit, performing an exercise stress test and a 24-h ECG Holter monitoring. Results: Acute success was achieved in 22 patients (85%). One case of recurrence was reported at short-term FU. Long-term FU, performed after a mean time of 150 ± 37 months, did not show ventricular preexcitation recurrences, with a success rate of 81%, and without late adverse events. Symptoms reduction (12% vs. 96%, p<.001) and lower rates of antiarrhythmic drug use (12% vs. 62%, p<.001) were observed at long term-FU with respect to baseline. This clinical outcome was detected also among patients who underwent unsuccessful CA at baseline. Conclusions: Our CA protocol confirmed remarkable safety and efficacy throughout a longterm FU. Significant clinical improvement in terms of antiarrhythmic therapy discontinuation and symptoms reduction was also shown among patients who experienced acute failure of CA