By Nadim G. Khan, Anne B. Curtis, Bengt Herweg, S. Serge Barold (auth.), S. Serge Barold MD, FRACP, FACP FACC, FESC, FHRS, Philippe Ritter MD (eds.)
The therapy of congestive center failure via implanted biventricular pacemakers, or cardiac resynchronization, has revolutionized the perform of implanting pacemakers and defibrillators. extra cardiac resynchronization remedy units than traditional pacemakers are actually being implanted and their numbers are turning out to be world wide. This entire quantity could be priceless to cardiologists, cardiac electrophysiologists, cardiac surgeons, cardiology fellows in education, extensive care experts and somebody drawn to pacing, ICDs and their follow-up.
S. Serge Barold, M.D., is medical Professor of drugs, collage of South Florida university of drugs and department of Cardiology, Tampa common clinic, Tampa, Florida, USA.
Philippe Ritter, M.D., is Chairman, Cardiostim InParys, St. Cloud, Clinique Bizet Paris, Clinique Chirurgicale Val d'Or, St Cloud, Paris, France.
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Additional resources for Devices for Cardiac Resynchronization: Technologic and Clinical Aspects
Ji S, Cesari D, Swerdww C, et al. Left ventricular endocardial lead placement using a modified transseptal approach. J Cardiovasc Electrophysiol 2004;15(2):234–6. 15. Sharifi M, Sorkin R, Sharifi V, et al. Inadvertent malposition of a transvenousinserted pacing lead in the left ventricular chamber. Am J Cardiol 1995;76(1):92–5. 16. Warfield DA, Hayes DL, Hyberger LK, et al. Permanent pacing in patients with univentricular heart. Pacing Clin Electrophysiol 1999;22(8):1193–201. 17. Gold MR, Rashba EJ.
Rarely, a combined inferior and superior approach is needed to overcome sheath kinking in the proximal CS. A deflectable electrophysiology catheter is placed in the CS ostium from the inferior approach and downward pressure is applied to “straighten” the “goose neck” segment. This may permit advancement of the CS sheath and guide catheters from the superior approach. Coronary Venous Anatomy: Absent or Seemingly Inaccessible Target Veins Despite rapid evolution of implantation techniques including guiding sheaths and catheters and over-the-wire (OTW) delivery systems, a suitable pacing site on the LV free wall cannot be achieved in 20–30% of patients.
This relates to implanter experience and other technical factors such as the lack of fixation mechanisms and stresses placed on the proximal portion of the lead at the junction of the right atrium and CS ostium. Lead dislodgments are readily identified by change in QRS duration and morphology on 12-lead electrocardiogram (ECG) as well as by chest radiography but usually suspected on the basis of device interrogation that discloses 4. Alternative CRT Techniques a significant decline in local signal amplitude and/or change in pacing capture threshold.