title: Effective long-term left atrial pacing using regular screw-in leads implanted within the coronary sinus.
abstract: Passive-fixation leads positioned inside the coronary sinus (CS) have been found to be effective in LA pacing and sensing, but their use is limited by a high incidence of early and late dislodgment. Since anatomic studies have shown that the proximal part of the CS is surrounded by a relatively thick musculature, the feasibility, safety, and efficacy of acute and chronic coronary sinus pacing via regular screw-in leads positioned within the first centimeters of the CS were evaluated as compared to passive-fixation leads. Thirty-three patients (21 men, age 62 +/- 10 years) underwent dual chamber pacemaker implantation with LA pacing obtained via passive-fixation leads (7 patients) or regular screw-in leads (26 patients). The former approach was prematurely abandoned because of a high rate of acute and late lead dislodgment (42%). The chronic pacing threshold was 1.7 +/- 1.0 V at 0.67-ms pulse width and 1.47 +/- 1.3 V at 0.5-ms pulse width for passive- and active-fixation leads, respectively. In the CS active-fixation lead group, no postoperative pericardial effusion, CS lead dislodgment, nor diaphragmatic stimulation were observed. In this last group, steroid eluting leads (14 patients) have a statistically lower pacing threshold than noneluting steroid leads (12 patients) (0.88 +/- 0.23 vs 2.29 +/- 1.68 V, P = 0.011) at long-term follow-up. The use of regular screw-in leads implanted within the CS allows effective and safe long-term LA pacing without risk of dislodgment.
authors.affiliation: Department of Cardiology, Rouen University Hospital, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Ouali
authors.forename: Frédéric
authors.initials: F
authors.lastname: Anselme
authors.forename: Françoise
authors.initials: F
authors.lastname: Hidden
authors.forename: Arnaud
authors.initials: A
authors.lastname: Savouré
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.forename: Nadir
authors.initials: N
authors.lastname: Saoudi
authors.forename: Robert
authors.initials: R
authors.lastname: Frank
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003331:Coronary Vessels; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013997:Time Factors