Early Experience with Attain Stability, an Active Fixation LV Lead: Virtues and Pitfalls
Background Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the N...
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Published in | Pacing and clinical electrophysiology Vol. 38; no. 3; pp. 297 - 301 |
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Main Authors | , |
Format | Journal Article |
Language | English |
Published |
Blackwell Publishing Ltd
01.03.2015
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Subjects | |
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Abstract | Background
Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the Netherlands) has shown promising results. We share our initial experience with this novel active fixation LV lead.
Methods
A Medtronic active fixation lead 20066 was used in eight consecutive patients for CRT. An optimal site was chosen and recommended maneuvers were applied for lead fixation. Push and pull maneuvers were used to test stability.
Results
There were two initial dislodgements after which we used a transvalvular insertion (TVI) tool that was used in the hemostatic valve during rotation of the lead so that the torque was easily transmitted to the tip. It also allowed better tactile feedback during push‐pull tests. There were no further dislodgements in the subsequent six patients. However, in one patient the lead could not be unscrewed due to the tip getting wedged at a distal smaller vein. Repositioning of the LV lead was done in three patients due to PNS or pacing issues. The median time for LV lead placement was 16.5 minutes (interquartile range 9–25 minutes).
Conclusion
The Medtronic Attain Stability 20066 active fixation LV lead can potentially be implanted at any pacing site avoiding PNS and providing better stability. The learning curve is short and additional tricks can be learnt to improve success. Use of TVI while the lead is rotated is beneficial. |
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AbstractList | Background
Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the Netherlands) has shown promising results. We share our initial experience with this novel active fixation LV lead.
Methods
A Medtronic active fixation lead 20066 was used in eight consecutive patients for CRT. An optimal site was chosen and recommended maneuvers were applied for lead fixation. Push and pull maneuvers were used to test stability.
Results
There were two initial dislodgements after which we used a transvalvular insertion (TVI) tool that was used in the hemostatic valve during rotation of the lead so that the torque was easily transmitted to the tip. It also allowed better tactile feedback during push‐pull tests. There were no further dislodgements in the subsequent six patients. However, in one patient the lead could not be unscrewed due to the tip getting wedged at a distal smaller vein. Repositioning of the LV lead was done in three patients due to PNS or pacing issues. The median time for LV lead placement was 16.5 minutes (interquartile range 9–25 minutes).
Conclusion
The Medtronic Attain Stability 20066 active fixation LV lead can potentially be implanted at any pacing site avoiding PNS and providing better stability. The learning curve is short and additional tricks can be learnt to improve success. Use of TVI while the lead is rotated is beneficial. |
Author | JOHAR, SOFIAN LUQMAN, NAZAR |
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CitedBy_id | crossref_primary_10_3389_fcvm_2021_734666 crossref_primary_10_1016_j_jjcc_2017_01_011 crossref_primary_10_1093_europace_euv227 crossref_primary_10_1016_j_ipej_2017_05_008 |
Cites_doi | 10.1016/j.hrthm.2014.04.020 10.1093/europace/eum082 10.1111/j.1540-8159.2008.01237.x 10.1016/j.amjcard.2005.08.030 10.1161/CIRCULATIONAHA.110.000646 10.1111/j.1540-8159.2010.03003.x 10.1056/NEJMoa032423 10.1056/NEJM200103223441202 10.1111/jce.12065 10.1093/eurheartj/eht150 10.1016/j.hrthm.2010.01.035 10.1093/europace/euq078 |
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References_xml | – volume: 97 start-page: 260 year: 2006 end-page: 263 article-title: Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy publication-title: Am J Cardiol – volume: 34 start-page: 484 year: 2011 end-page: 489 article-title: Initial single‐center experience of a quadripolar pacing lead for cardiac synchronization publication-title: Pacing Clin Electrophysiol – volume: 24 start-page: 449 year: 2012 end-page: 456 article-title: Post operative performance of the Quartet left ventricular heart lead publication-title: J Cardiovasc Electrophysiol – volume: 34 start-page: 2281 year: 2013 end-page: 2329 article-title: 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy publication-title: Eur Heart J – volume: 350 start-page: 2140 year: 2004 end-page: 2150 article-title: Cardiac‐resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure publication-title: N Engl J Med – volume: 11 start-page: 1150 year: 2014 end-page: 1155 article-title: Novel active fixation mechanism permits precise placement of a left ventricular lead: Early results from a multicenter clinical study publication-title: Heart Rhythm – volume: 7 start-page: 639 year: 2010 end-page: 644 article-title: Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes publication-title: Heart Rhythm – volume: 12 start-page: 825 year: 2010 end-page: 829 article-title: Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus lead publication-title: Europace – volume: 344 start-page: 873 year: 2001 end-page: 880 article-title: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay publication-title: N Engl J Med – volume: 9 start-page: 523 year: 2007 end-page: 527 article-title: Single‐centre experience with coronary sinus lead stability and long‐term pacing parameters publication-title: Europace – volume: 31 start-page: 1628 year: 2008 end-page: 1639 article-title: Noninvasive imaging in cardiac resynchronization therapy—Part 2: Follow‐up and optimization of settings publication-title: Pacing Clin Electrophysiol – volume: 123 start-page: 1159 year: 2011 end-page: 1166 article-title: Left ventricular lead position and clinical outcome in the Multicenter Automatic Defibrillator Implantation Trial‐Cardiac Resynchronization Therapy (MADIT‐CRT) Trial publication-title: Circulation – ident: e_1_2_6_9_1 doi: 10.1016/j.hrthm.2014.04.020 – ident: e_1_2_6_6_1 doi: 10.1093/europace/eum082 – ident: e_1_2_6_4_1 doi: 10.1111/j.1540-8159.2008.01237.x – ident: e_1_2_6_3_1 doi: 10.1016/j.amjcard.2005.08.030 – ident: e_1_2_6_7_1 doi: 10.1161/CIRCULATIONAHA.110.000646 – ident: e_1_2_6_12_1 doi: 10.1111/j.1540-8159.2010.03003.x – ident: e_1_2_6_2_1 doi: 10.1056/NEJMoa032423 – ident: e_1_2_6_5_1 doi: 10.1056/NEJM200103223441202 – ident: e_1_2_6_13_1 doi: 10.1111/jce.12065 – ident: e_1_2_6_8_1 doi: 10.1093/eurheartj/eht150 – ident: e_1_2_6_10_1 doi: 10.1016/j.hrthm.2010.01.035 – ident: e_1_2_6_11_1 doi: 10.1093/europace/euq078 |
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Snippet | Background
Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic... |
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SubjectTerms | active fixation LV lead Attain Stability 20066 active fixation LV lead CRT |
Title | Early Experience with Attain Stability, an Active Fixation LV Lead: Virtues and Pitfalls |
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