Key result
Implantation of the Medtronic Attain Stability 20066 active fixation LV lead in 8 patients resulted in 2 initial dislodgements, 3 repositionings, and a median placement time of 16.5 minutes.
Why the study?
Does the Attain Stability 20066 active fixation LV lead provide stable placement and avoid phrenic nerve stimulation in patients undergoing CRT?
Observational (n=8)
Does the Attain Stability 20066 active fixation LV lead provide stable placement and avoid phrenic nerve stimulation in patients undergoing CRT?
The Attain Stability 20066 active fixation LV lead can be successfully implanted with a short learning curve, aided by the use of a transvalvular insertion tool to prevent dislodgement.
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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Johar et al. (2014) conducted an observational in Cardiac resynchronization therapy (CRT) (n=8). Medtronic Attain Stability 20066 active fixation LV lead was evaluated on Lead dislodgement. Implantation of the Medtronic Attain Stability 20066 active fixation LV lead in 8 patients resulted in 2 initial dislodgements, 3 repositionings, and a median placement time of 16.5 minutes.
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