title: A new endocardial "over-the-wire" or stylet-driven left ventricular lead: first clinical experience.
abstract: Transvenous left ventricular (LV) leads are primarily inserted "over-the-wire" (OTW). However, a stylet-driven (SD) approach may be a helpful alternative. A new polyurethane-coated, unipolar LV lead can be placed either by a stylet or a guide wire, which can be inserted into the lead body from both ends. The multicenter OVID study evaluates the clinical performance of this new steroid- and nonsteroid eluting lead. The primary endpoint is the LV lead implant success rate after identification of the coronary sinus (CS). Secondary endpoints include complication rate, short- and long-term lead characteristics, overall procedure and LV lead placement duration, total fluoroscopy time, and lead handling characteristics ratings. To date, 96 patients with heart failure (68 +/- 9 years old, 76% men) are enrolled. The CS was identified in 95 patients and, in 85 (88.5%), the LV lead was successfully implanted. The final lead positioning was lateral in 41%, posterolateral in 35%, anterolateral in 18%, and great cardiac vein in 6% of patients. In 70%, the 85 successful implantations, both stylet-driven and guide-wire techniques were used, a stylet only was used in 22%, and a guide wire only in 8%. Mean overall duration of 85 successful procedures was 112 +/- 40 minutes, total fluoroscopy time 28 +/- 15 minutes, and the duration of LV lead placement was 35 +/- 29 minutes. During a 3-month follow-up, the loss of LV capture occurred in three and phrenic nerve stimulation in six patients. The mean long-term pacing threshold is 0.8 V/0.5 ms and pacing impedance is 550 Omega. The OVID data suggest that these new leads are safe and effective. The choice of both OTW and SD techniques during lead implantation offers greater procedural flexibility.
authors.affiliation: St Peter's Hospital, Chertsey, Surrey, United Kingdom. sue.ellery@asph.nhs.uk
authors.forename: Sue
authors.initials: S
authors.lastname: Ellery
authors.forename: Vince
authors.initials: V
authors.lastname: Paul
authors.forename: Guenther
authors.initials: G
authors.lastname: Prenner
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Tscheliessnigg
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.forename: Klaus
authors.initials: K
authors.lastname: Malinowski
authors.forename: Gerd
authors.initials: G
authors.lastname: Fröhlig
authors.forename: Florian
authors.initials: F
authors.lastname: Hintringer
authors.forename: Olaf
authors.initials: O
authors.lastname: Bosse
authors.forename: Paolo
authors.initials: P
authors.lastname: Diotallevi
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Ravazzi
authors.forename: Horst
authors.initials: H
authors.lastname: Flathmann
authors.forename: Dejan
authors.initials: D
authors.lastname: Danilovic
authors.forename: Christina
authors.initials: C
authors.lastname: Unterberg-Buchwald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial