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Use of a quadripolar left ventricular lead to achieve successful implantation in patients with previous failed attempts at cardiac resynchronization therapy.

Shetty AK, Duckett SG, Bostock J, Rosenthal E, Rinaldi CA - Europace (2011)

Bottom Line: In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus.Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome.Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.

View Article: PubMed Central - PubMed

Affiliation: Cardiothoracic Department, Guys and St Thomas' Hospital NHS Foundation Trust, and King's College London, London, UK. anoop.shetty@kcl.ac.uk

ABSTRACT

Aims: Problems with implanting a left ventricular (LV) lead during cardiac resynchronization therapy (CRT) procedures are not uncommon and may occur for a variety of reasons including phrenic nerve stimulation (PNS) and high capture thresholds. We aimed to perform successful CRT in patients with previous LV lead problems using the multiple pacing configurations available with the St Jude Quartet model 1458Q quadripolar LV lead to overcome PNS or high capture thresholds.

Methods and results: Four patients with previous failed attempts at LV lead implantation underwent a further attempt at CRT using a Quartet lead. In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus. Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome. Satisfactory lead parameters were seen at implant, pre-discharge, and at short-term follow-up (8.5±5 weeks).

Conclusion: The Quartet lead allows 10 different pacing vectors to be used and may overcome common pacing problems because of the multiple pacing configurations available. Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.

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Related in: MedlinePlus

Ten vectors are available using the three ring electrodes and distal tip of the Quartet lead and the RV coil: 1. distal 1 (D1) to mid 2 (M2); 2. D1 to proximal 4 (P4); 3. D1–RV coil; 4. M2–P4; 5. M2–RV coil; 6. mid 3 (M3) to M2; 7. M3–P4; 8. M3–RV coil; 9. P4–M2; and 10. P4–RV coil (image courtesy of St Jude Medical).
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EUR032F1: Ten vectors are available using the three ring electrodes and distal tip of the Quartet lead and the RV coil: 1. distal 1 (D1) to mid 2 (M2); 2. D1 to proximal 4 (P4); 3. D1–RV coil; 4. M2–P4; 5. M2–RV coil; 6. mid 3 (M3) to M2; 7. M3–P4; 8. M3–RV coil; 9. P4–M2; and 10. P4–RV coil (image courtesy of St Jude Medical).

Mentions: The Quartet LV lead model 1458Q (St Jude Medical, Sylmar, CA, USA) is a multipolar LV lead with three ring electrodes in addition to the tip electrode. The three ring electrodes are located 20, 30, and 47 mm from the tip that has a 4.0 Fr diameter. The maximum lead body diameter is 4.7 Fr and the lead is easily manoeuvrable. The Quartet lead allows all four of the electrodes on the lead to act as the cathode and two also as an anode. In addition, the right ventricular (RV) coil of the shocking lead may act as an anode thus giving 10 possible bipolar and unipolar pacing configurations (see Figure 1). Theoretically, a change in pacing vector may allow problems not only with PNS to be overcome but also with unsatisfactory pacing capture thresholds. In the temporary setting, Thibault et al.10 reported that problems with PNS could be overcome with ‘electronic repositioning’ of the Quartet lead by changing the pacing vector. Forleo et al.11 have compared the Quartet lead with conventional bipolar leads and found it to be associated with a reduced need for lead revision or reprogramming. We report a series of four patients, all of whom had previously had a failed LV lead implantation attempt and who went on to have successful CRT using a Quartet lead.Figure 1


Use of a quadripolar left ventricular lead to achieve successful implantation in patients with previous failed attempts at cardiac resynchronization therapy.

Shetty AK, Duckett SG, Bostock J, Rosenthal E, Rinaldi CA - Europace (2011)

Ten vectors are available using the three ring electrodes and distal tip of the Quartet lead and the RV coil: 1. distal 1 (D1) to mid 2 (M2); 2. D1 to proximal 4 (P4); 3. D1–RV coil; 4. M2–P4; 5. M2–RV coil; 6. mid 3 (M3) to M2; 7. M3–P4; 8. M3–RV coil; 9. P4–M2; and 10. P4–RV coil (image courtesy of St Jude Medical).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3120132&req=5

EUR032F1: Ten vectors are available using the three ring electrodes and distal tip of the Quartet lead and the RV coil: 1. distal 1 (D1) to mid 2 (M2); 2. D1 to proximal 4 (P4); 3. D1–RV coil; 4. M2–P4; 5. M2–RV coil; 6. mid 3 (M3) to M2; 7. M3–P4; 8. M3–RV coil; 9. P4–M2; and 10. P4–RV coil (image courtesy of St Jude Medical).
Mentions: The Quartet LV lead model 1458Q (St Jude Medical, Sylmar, CA, USA) is a multipolar LV lead with three ring electrodes in addition to the tip electrode. The three ring electrodes are located 20, 30, and 47 mm from the tip that has a 4.0 Fr diameter. The maximum lead body diameter is 4.7 Fr and the lead is easily manoeuvrable. The Quartet lead allows all four of the electrodes on the lead to act as the cathode and two also as an anode. In addition, the right ventricular (RV) coil of the shocking lead may act as an anode thus giving 10 possible bipolar and unipolar pacing configurations (see Figure 1). Theoretically, a change in pacing vector may allow problems not only with PNS to be overcome but also with unsatisfactory pacing capture thresholds. In the temporary setting, Thibault et al.10 reported that problems with PNS could be overcome with ‘electronic repositioning’ of the Quartet lead by changing the pacing vector. Forleo et al.11 have compared the Quartet lead with conventional bipolar leads and found it to be associated with a reduced need for lead revision or reprogramming. We report a series of four patients, all of whom had previously had a failed LV lead implantation attempt and who went on to have successful CRT using a Quartet lead.Figure 1

Bottom Line: In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus.Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome.Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.

View Article: PubMed Central - PubMed

Affiliation: Cardiothoracic Department, Guys and St Thomas' Hospital NHS Foundation Trust, and King's College London, London, UK. anoop.shetty@kcl.ac.uk

ABSTRACT

Aims: Problems with implanting a left ventricular (LV) lead during cardiac resynchronization therapy (CRT) procedures are not uncommon and may occur for a variety of reasons including phrenic nerve stimulation (PNS) and high capture thresholds. We aimed to perform successful CRT in patients with previous LV lead problems using the multiple pacing configurations available with the St Jude Quartet model 1458Q quadripolar LV lead to overcome PNS or high capture thresholds.

Methods and results: Four patients with previous failed attempts at LV lead implantation underwent a further attempt at CRT using a Quartet lead. In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus. Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome. Satisfactory lead parameters were seen at implant, pre-discharge, and at short-term follow-up (8.5±5 weeks).

Conclusion: The Quartet lead allows 10 different pacing vectors to be used and may overcome common pacing problems because of the multiple pacing configurations available. Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.

Show MeSH
Related in: MedlinePlus