title: Minimal Invasive Left Ventricular Lead Repositioning is Safe and Effective in Distal Left Ventricular Lead Positions.
abstract: BACKGROUND
  Treatment of left ventricular electrode dislocation and phrenic nerve stimulation remains an issue in the era of new electrode designs.
  
  
  METHODS
  Safety and efficacy of minimal invasive lead repositioning and pocket opening reposition procedures were evaluated between December 2005 and December 2012 at our center. Minimal invasive method was developed and widely utilized at our center to treat phrenic nerve stimulation. The distally positioned left ventricular lead is looped around by a deflectable catheter in the right atrium introduced from the femoral vein access and then pulled back. Coronary stent implantation was used afterwards for lead stabilization in some patients.
  
  
  RESULTS
  42 minimal invasive and 48 electrode repositions with pacemaker pocket opening were performed at 77 patients for left ventricular lead problems. Minimal invasive reposition could be carried out successfully in 69% of (29 patients) cases. Note that in 14.3% of the cases (six patients) minimal invasive procedures were acutely unsuccessful and crossover was necessary. In 16.6% of the cases (seven patients) lead issues were noted later during follow-up. Opening of the pocket could be carried out successfully in 81.2% (39 patients) and was unsuccessful acutely in 6.25% (three patients). Repeated dislocation was noticed, 12.5%, in this group (six patients). Complication during minimal invasive procedures was electrode injury in one case. Pocket openings were associated with several complications: atrial fibrillation, pericardial effusion, fever, hematoma, and right ventricular electrode dislodgement.
  
  
  CONCLUSIONS
  Minimal invasive procedure-as the first line approach-is safe and feasible for left ventricular electrode repositioning in selected cases.
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Osztheimer
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Szilágyi
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Pongor
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Endre
authors.initials: E
authors.lastname: Zima
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Levente
authors.initials: L
authors.lastname: Molnár
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Tahin
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Semmelweis University Heart and Vascular Center, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gellér
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004869:Equipment Safety / Q000706:statistics & numerical data; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: device-associated complications; electrode dislodgement; left ventricular lead; minimal invasive