Failure of the Active‐Fixation Mechanism during Removal of Active‐Fixation Pacing Leads

Cano, Óscar; Osca, Joaquín; Sancho‐Tello, María‐José; Olagüe, José; Castro, José Enrique; Salvador, Antonio

doi:10.1111/j.1540-8159.2011.03153.x

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…First, since successful HBP and LBBP are electrically driven with evidence of His‐Purkinje capture during active fixation, lead repositioning is often inevitable and may require multiple attempts. EHL with previous repositioning attempts were more likely to encounter active fixation mechanism failure on extraction, with damage mainly limited to the helix 14 . Second, lead damage, extraction, use of mechanical extraction tools and subsequent lead replacements add to overall costs for the patient.…”

Section: Discussionmentioning

confidence: 99%

Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing

Tan

Lee

Boey

et al. 2022

Cardiovasc electrophysiol

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Introduction: Pacing leads with extendable-retractable helix (EHL) are alternatives to fixed-helix leads (FHL) for conduction system pacing (CSP), but data on handling characteristics are limited. This study evaluated a dual-center experience of lead handling and performance during CSP.Methods and Results: Consecutive patients with His-bundle pacing (HBP) or left bundle branch pacing (LBBP) were evaluated for the primary outcome of lead failure, defined as structural damage to the lead necessitating lead replacement. Differences in pacing characteristics were compared. Among 280 patients (mean age 74 ± 11 years, 44% male, 50% LBBP), 246 (88%) received FHL and 34 (12%) received EHL. Of 299 leads used, lead failure occurred more frequently among patients with EHL than FHL (29% vs. 2%, p < .001), regardless of CSP modality.Majority of damaged leads (89%) in the form of helix deformation were successfully removed, with failure occurring in only two patients, both EHL, leading to helix fracture and retention within the septal myocardium. EHL, compared to FHL, was associated with 25-fold increased odds of lead failure (odds ratio: 25.21, 95% confidence interval: 7.35-86.51), and persisted after adjustment in turn for age, pacing modality and indication. CSP implant success rates did not differ by lead design (FHL 80% vs. EHL 71%, p = .18), with similar pacing thresholds at implant and follow-up. Conclusion:Helix deformation and fracture were more frequent with EHL in CSP despite similar implant success. These findings have significant implications for lead selection during CSP and raises concerns about the long-term extractability of EHL in CSP.

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Section: Discussionmentioning

confidence: 99%

Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing

Tan

Lee

Boey

et al. 2022

Cardiovasc electrophysiol

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“… 13 With the continuous development of pacing technology, the utilization rate of the active fixation lead is increasing. 14 The tip of the active fixation lead is a screw, which rotates out of the spiral structure during implantation and rotates into the myocardium, and it can be placed anywhere in the cardiac cavity.…”

Section: Discussionmentioning

confidence: 99%

Implantation of a dual-chamber pacemaker in a patient with dextrocardia and sick sinus syndrome: a case report

et al. 2022

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Dextrocardia is a congenital abnormal position of the heart in which the main part of the heart is in the right chest, and the long axis of the heart points to the lower right. Cases of a combination of dextrocardia and sick sinus syndrome are rare. A 65-year-old female patient was admitted to hospital with palpitations and dizziness for 1 week. Mirror-image dextrocardia and sick sinus syndrome were diagnosed by an electrocardiogram, echocardiography, Holter monitoring, and X-rays. Finally, we successfully implanted a dual-chamber pacemaker into the patient. The patient had an uneventful recovery and was discharged when her symptoms had greatly improved 1 week later. When dextrocardia is present, using active fixation leads in the atrial and ventricular leads is easier for finding the pacing position with optimal sensing and pacing thresholds, and they reduce the incidence of falling off.

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“…It have "tines" at the end of the lead, so that it can be embedded in the trabecular muscles acutely, after a period of time, the myocardium around it will brose to secure it further [12] . With the continuous development of pacing technology, the utilization rate of active xation lead is getting higher and higher [13] . The tip of active xation lead is a screw, which rotates out of the spiral structure during implantation and rotates into the myocardium, which can be placed anywhere in the cardiac cavity.…”

Section: Discussionmentioning

confidence: 99%

Implantation of DDD Pacemaker in a Patient With Dextrocardia and Sick Sinus Syndrome: A Case Report

Luo

Zhou

Chen

et al. 2021

Preprint

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Background: Dextrocardia is a congenital abnormal position of the heart in which the main part of the heart is in the right chest and the long axis of the heart points to the lower right, cases with combination of dextrocardia and sick sinus syndrome are rare.Case presentation: A 65-year-old female patient was admitted with palpitations and dizziness for 1 week. Mirror-image Dextrocardia and sick sinus syndrome was diagnosed by electrocardiogram (ECG), echocardiography, Holter monitoring, and X-ray. The rarity of the case and the specificity of anatomy brought great challenges to our interventional treatments. Finally, we successfully implanted a DDD pacemaker into the patient.Conclusion: For dextrocardia, using active fixation leads in both atrial and ventricular leads is easier to find the position with optimal sensing and pacing threshold, which also have a lower and more stable pacing threshold and can reduce the incidence of falling off at the same time. During operation, combine the multiple positions under fluoroscopy to confirm the leads position, which can improve the success rate of implantation.

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Failure of the Active‐Fixation Mechanism during Removal of Active‐Fixation Pacing Leads

Abstract: In our series, the active-fixation mechanism failed in up to 22.5% of explanted leads. This may have important clinical implications during active-fixation lead removal and reposition.

Cited by 7 publications

References 12 publications

Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing

Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing

Implantation of a dual-chamber pacemaker in a patient with dextrocardia and sick sinus syndrome: a case report

Implantation of DDD Pacemaker in a Patient With Dextrocardia and Sick Sinus Syndrome: A Case Report

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