Key result
Permanent stylet technique prevents CS lead dislocation with stable pacing thresholds over 12 months.
Why the study?
Coronary sinus lead dislocation rates remain high despite recent developments in cardiac resynchronization therapy leads.
Does the permanent stylet technique prevent coronary sinus lead dislocation in patients receiving cardiac resynchronization therapy?
Observational (n=35)
Does the permanent stylet technique prevent coronary sinus lead dislocation in patients receiving cardiac resynchronization therapy?
The permanent stylet technique appears to be a safe and effective method to stabilize coronary sinus leads and prevent dislocation over 1 year of follow-up.
May support stable CS lead placement without dislocation; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: Coronary sinus (CS) leads used for cardiac resynchronization have undergone development in the last years. However, dislocation rate remained high. We explain a simple method to stabilize the CS lead position. METHODS AND RESULTS: Thirty-five patients (11 females, aged 60 +/- 9.2 years) were treated with this method. An over-the-wire left ventricular (LV) pacing lead system was introduced and lodged in the vessel. Then, a stiff stylet was inserted and kept into the CS lead and end of the stylet was cut by a scissor (permanent stylet technique). Pacing and sensing properties of all leads were checked and the guiding sheath was removed. Control echocardiography did not show pericardial effusion. The mean LVpacing threshold was 1.2 +/- 0.8 V and the mean impedance was 625 +/- 143 Omega at the implantation. During follow-up (12.5 +/- 2.5 months), there were no statistically significant changes in pacing threshold and impedance when compared with the implantation measurements. At the last patient visit, the mean LV pacing threshold was 1.1 +/- 0.8 V and the mean impedance was 620 +/- 140 Omega. Impedance measurements did not suggest lead insulation failure. No LV lead dislocations were detected in our 35 cases during the follow-up. CONCLUSION: Permanent stylet technique seems to be a safe and effective procedure to stabilize CS lead position as demonstrated by our 1-year long follow-up results.
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Sharifkazemi et al. (2007) conducted an observational in Cardiac resynchronization therapy (n=35). Permanent stylet technique was evaluated on LV lead dislocations. The permanent stylet technique for coronary sinus lead stabilization resulted in 0 lead dislocations among 35 patients over a mean follow-up of 12.5 months, with stable pacing thresholds.
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