Cath Lab Digest - April 2008 - (Page 39)

39 To implant the lead, the standard “Floppy Firm” guidewire (model 4078G, St. Jude Medical) was advanced to well beyond the tortuosity. Using an over-the-wire approach — after some initial difficulty — the lead was maneuvered through the 90-degree turn and advanced smoothly past the of anxiety or panic attacks. His QRS narrowed to 155 ms, and he demonstrated excellent ECG characteristics of textbook lead placement with good LV capture (Figure 5). Despite the deconditioning, the patient’s heart failure symptoms decreased from Class III, borderline Class IV symptoms, to NYHA Class I–II symptoms. proximal challenges. It was placed in the true, left lateral mid-ventricular position — an extremely secure position because the proximal tortuosity now worked as an advantage, stabilizing the lead and passively anchoring it into place (Figure 4). Biventricular pacing morphology revealed an initial negative vector in lead I and a positive vector in V1. Additional confirmation was performed. ECGs were recorded with RV only, LV only, and biventricular pacing. Biventricular pacing was a fusion of RV and LV only morphologies. About the Lead The QuickSite XL lead was the best choice for this case since it has a polyurethane body that provides good pushability, a steerable, deflectable tip, and a large s-shaped curve to provide stability and maneuverability. The proximal polyurethane section and cable/coil conductors offer exceptional push and torque, while the flexible distal silicone portion is designed for improved maneuverability in tortuous anatomy. The lead also has had excellent implant success rates and stability; in clinical studies, the QuickSite family of LV leads was shown to have an implant success rate of 97% and a dislodgement rate of only 1%.1 Conclusion The QuickSite XL 1058T lead effectively navigated tortuous anatomy for a successful implantation in the coronary sinus. The addition of the coronary sinus lead allowed for biventricular pacing that improved the QoL as well as the heart failure symptoms of this patient. The availability of a bipolar lead with enough flexibility and maneuverability to navigate the tortuous coronary sinus made it possible to use — instead of a unipolar lead — during the lead placement. The availability of this flexible bipolar lead option provided the patient optimal therapy for his clinical condition. In summary, I believe the QuickSite lead family would be an appropriate choice for physicians uncertain about the ability of bipolar LV leads to maneuver through difficult anatomy. The stability, low dislodgement rate, s-shaped curve and steerable tip make the QuickSite lead a good choice for optimal, stable LV lead placement. The author can be contacted at mtrojan@oregoncadiology.com Reference 1. QuickSite® Lead Family data represents data pooled on the QuickSite Models 1056K and QuickSite Model 1056T from the RHYTHM ICD/QuickSite Model 1056K lead study (163 patients) and the RHYTHM ICD/QuickSite Model 1056T lead study (144 patients) [QuickSite Models 1056K and 1056T lead user’s manual]/© 2005 St. Jude Medical. Follow-Up and Results The patient was seen at one-week, two-week and two-month follow-up appointments, and has had an excellent clinical outcome. He reported feeling better after two weeks, and, although he reported some fatigue, it was primarily due to typical deconditioning observed in most Class III patients. The patient reported that his only regret was not doing the procedure earlier. Despite the deconditioning, the patient’s heart failure symptoms decreased from Class III, borderline Class IV symptoms, to NYHA Class I–II symptoms. He has had resolution of his angina and no further episodes Figure 4. Still image following deployment of LV lead in LAO projection. Image capture prior to removal of St. Jude Medical guide catheter. The LV lead in stable position after removal of guidewire. The lead did decrease the tortuosity of the lateral branch. Figure 5. ECG following implant. ECG demonstrates continued atrial pacing and biventricular capture. Note that biventricular paced morphology is a fusion of LV and RV only pacing. http://cardiacservicesinc.com http://cardiacservicesinc.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - April 2008

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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