<b>Atrial Pacing Leads Following Open Heart Surgery</b>: Active or Passive Fixation?

Connelly, Derek T.; Steinhaus, David; Handlin, Larry R.; Lemery, Robert; Moutray, Kelly L.; Foley, Laura; Davie, Scott; Cardinal, Debbie; Lipke, Janet

doi:10.1111/j.1540-8159.1997.tb06082.x

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…It should be emphasized that contrary to a common belief, history of coronary artery bypass graft (CABG) is not a contraindication for use of a passive atrial lead and the rate of dislocation of passive fixation atrial leads in patients following coronary artery bypass graft is not higher. 3,10 What is the reason for differences between our results and Zoppo et al's results? There are several possible explanations for these differences.…”

contrasting

confidence: 68%

“…Moreover, future growth may also favor the use of active fixation leads in children, as does the use of small diameter leads. It should be emphasized that contrary to a common belief, history of coronary artery bypass graft (CABG) is not a contraindication for use of a passive atrial lead and the rate of dislocation of passive fixation atrial leads in patients following coronary artery bypass graft is not higher 3,10 …”

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confidence: 96%

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The Choice of an Atrial Lead—To Each His/Her Own

Glikson

Luria

2011

Pacing Clinical Electrophis

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More than 50% of arrhythmia-management devices implanted today include a right atrial lead. While the structure of the right ventricle and its apex ensures an easy implantation procedure of even the simplest straight-pacing lead, the structure of the atrium is less friendly, necessitating the use of special shapes and fixation mechanisms to stabilize the lead. Despite major advances over the years in technology and design and a major decrease in complication rates, the use of atrial leads still carries a somewhat higher rate of complications, including infections and dislodgements. 1 Given this relative difficulty with atrial lead implantation and the variety of commercially available leads, it is important that the choice of lead be based on knowledge and understanding of the available data on success rate, complications, and performance of the various available atrial leads, as well as on personal experience and preferences. So far, approaches vary widely among different implanters.When selecting a lead, the following variables should be considered: lead shape (J vs straight), size, fixation mechanisms (passive vs active as well as different mechanisms of active fixation), and long-term performance.In the current issue of PACE, Zoppo et al. 2 published a retrospective nonrandomized shortterm comparison of the use of straight screw-in leads in the atrium in comparison with either passive (which formed the majority) or active "J"-shaped leads. They reported a remarkable lack of any dislodgement over the first three months in a group of 165 patients with straight atrial leads, as compared to higher dislodgement rates of about 2% in passive as well as active "J" leads. The rate of other complications, including pericardial complications, was very low in all three groups. Implant thresholds were somewhat higher in active fixation leads as compared with the passive leads. There was no long-term followup of either complications or pacing thresholds.Our somewhat different experience will be reviewed here and will include key evidence in the literature for each one of several factors involved in the selection of a lead:Shape of the lead: One of the features that enables stable localization of the lead in the right atrial appendage is a preformed "J" shape that maintains the tip in an upright position against the appendage or the right atrial wall. "J"-shaped leads may have either an active or a passive fixation mechanism, as opposed to straight leads that are used in the atrium, almost all of which have active fixation to prevent dislodgement. Therefore, the main issue to be examined when choosing a straight versus J atrial lead is its stability and threshold over time (both macro dislocation and stability of thresholds over time).In contrast to the study of Zoppo et al., our experience in a large-retrospective series of more than 500 patients implanted with a J-shaped passive lead showed a less than 1% rate of any complication, including dislodgement. Long-term performance of these leads was also excellent. 3 This diff...

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confidence: 96%

The Choice of an Atrial Lead—To Each His/Her Own

Glikson

Luria

2011

Pacing Clinical Electrophis

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“…Several investigators have compared the long-term performance of screwin and tined atrial electrodes in general populations of paced patients. [4][5][6] Closer inspection of these articles reveals a substantial number of defects in screw-in electrodes during long-term follow-up, such as increases in stimulation or sensing thresholds, loss of capture or sensing, entrapment of the tricuspid valve or chorda tendinae and lead dislodgement compared to tined electrodes, and the durability of the screw portion has been questioned. 4,5) Connelly et al demonstrated that at implantation, sensed Pwave amplitudes were similar in both types of leads, but lead impedance and pacing threshold were significantly higher for screw-in electrodes compared to tined electrodes, and during follow-up, atrial pacing thresholds were significantly higher and sensed P-wave amplitudes significantly lower in patients with screw-in electrodes compared to those with tined electrodes.…”

Section: Discussionmentioning

confidence: 99%

“…Loss of sensing occurred in 16% of patients with screw-in electrodes. 6) Connelly et al also reported the challenge of implanting a tined electrode into the right atrium in 46 patients with previous cardiac operation. Although, a stable atrial position with satisfactory pacing and sensing thresholds was obtained in 40 of the 46 patients, 6 patients required a change to screw-in electrodes during implantation.…”

Section: Discussionmentioning

confidence: 99%

Implantation of a Permanent Tined Endocardial Electrode into Right Atrium during Open‐heart Surgery: Report of 3 Cases

Tsutsumi

Niibori

Katsumoto

2005

Journal of Arrhythmia

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Given concerns regarding electrode fixation and risk of dislodgement, transvenous implantation of a tined endocardial electrode into the right atrium is considered difficult in patients who require permanent atrial pacing following cardiac surgery. Implantation of a tined endocardial electrode into the right atrium was performed intraoperatively for 3 patients who required implantation of a permanent atrial electrode during the cardiac operation. This technique yielded excellent results during the mean follow-up period of 65 months, with low stimulation thresholds (mean 2.85 mJ), sufficiently high sensing thresholds (mean 2.23 mV) and stable lead impedances (mean 491.7 ohm). This technique offers a useful and secure method for patients with preoperative bradycardial arrhythmias who require implantation of a permanent atrial electrode during open-heart surgery. (J Arrhythmia 2005; 21: 475-479)

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Techniques of Pacemaker Implantation and Removal

Marine¹,

Brinker²

2005

Cardiac Pacing and ICDs

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Atrial Pacing Leads Following Open Heart Surgery: Active or Passive Fixation?

Cited by 9 publications

References 11 publications

The Choice of an Atrial Lead—To Each His/Her Own

The Choice of an Atrial Lead—To Each His/Her Own

Implantation of a Permanent Tined Endocardial Electrode into Right Atrium during Open‐heart Surgery: Report of 3 Cases

Techniques of Pacemaker Implantation and Removal

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