title: Implantation techniques and chronic lead parameters of biventricular pacing dual-chamber defibrillators.
abstract: BACKGROUND
  The aim of this study is to describe implantation techniques and lead performance for biventricular pacing, dual-chamber implantable cardioverter defibrillators (ICDs).
  
  
  RESULTS
  A dual-chamber ICD with biventricular pacing was implanted in 87 patients with congestive heart failure (ejection fraction: 0.21 +/- 0.09), prolonged QRS duration (161 +/- 22 msec), and an indication for ICD therapy. Left ventricular pacing was achieved with a thoracotomy approach (n = 21) or a nonthoracotomy approach (n = 66). With a thoracotomy, biventricular devices were implanted successfully in all patients. During follow-up (17 +/- 11 months), 9 patients died (43%), 2 underwent transplantation, and 2 required left ventricular lead revision. At last follow-up, biventricular sensing and capture threshold were 11 +/- 5 mV and 1.5 +/- 0.8 V, respectively. For nonthoracotomy procedures, two types of coronary sinus (CS) leads were implanted: an over-the-wire lead (n = 45) and a shaped lead (n = 21). The rate of successful implantation (overall: 89%) (over-the-wire 93% vs shaped 81%; P = 0.1) and durations for CS lead placement (66 +/- 50 vs 58 +/- 34 min, P = 0.6) and the procedure (133 +/- 58 vs 129 +/- 33 min, P = 0.8) were not different between the two CS leads. During follow-up (11 +/- 9 months), 9 patients died (14%), and the shaped CS lead dislodged in 3 patients (3 shaped vs 0 over-the-wire, P = 0.01). At last follow-up, biventricular sensing and capture threshold were 10 +/- 4 mV and 1.8 +/- 0.7 V, respectively, and there was no difference between over-the-wire and shaped leads. By multivariate analysis, mortality was associated with absence of spironolactone therapy but not procedural features.
  
  
  CONCLUSIONS
  Nonthoracotomy CS lead implantation is feasible, with a success rate of about 90% and few adverse events. For the remaining 10%, a thoracotomy approach can be completed safely in these ill patients without increased risk for death.
authors.affiliation: MidOhio Cardiology, MidWest Research Foundation, Riverside-Methodist Hospital, Columbus 43214, USA. egd@mocc.cc
authors.forename: Emile G
authors.initials: EG
authors.lastname: Daoud
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kalbfleisch
authors.forename: John D
authors.initials: JD
authors.lastname: Hummel
authors.forename: Raul
authors.initials: R
authors.lastname: Weiss
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Augustini
authors.forename: Steven B
authors.initials: SB
authors.lastname: Duff
authors.forename: Georgia
authors.initials: G
authors.lastname: Polsinelli
authors.forename: John
authors.initials: J
authors.lastname: Castor
authors.forename: Tejas
authors.initials: T
authors.lastname: Meta
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States