EP Lab Digest - March 2008 - (Page 37)

MARCH 2008 EP CASE STUDY 37 Figure 3. The St. Jude Medical QuickSite XL lead (Model 1058T) with large sshaped curve fixation mechanism and steerable tip. 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. CASE STUDY Continued from page 34 proximal tortuosity now worked as an advantage, stabilizing the lead and passively anchoring it into place (Figure 4). 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 I–II symptoms. He has had resolution of his angina and no further episodes 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). 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. Despite the deconditioning, the patient’s heart failure symptoms decreased from Class III, borderline Class IV symptoms, to NYHA Class I–II symptoms. 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. 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, sshaped curve and steerable tip make the QuickSite lead a good choice for optimal, stable LV lead placement. 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 Editor’s Note: This article underwent peer review by one or more members of EP Lab Digest’s editorial board. http://www.epcatheters.com http://www.epcatheters.com

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EP Lab Digest - March 2008 ECG 101: The Case of a Dizzy Patient with a Left Bundle Branch Block Delayed Defibrillation: Research and Results Interview with Paul S. Chan, MD Contents Letter from the Editor Spotlight Interview: St. Joseph’s Hospital Health Center Parent Heart Watch from 36,000 Feet… Perspectives from the Annual Leadership Conference Clinical Trial Overview: 2008 Are MRI-Safe Pacemakers and Leads on the Horizon? Q & A with J. Rod Gimbel, MD Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead Email Discussion Group: March 2008 Guidelines on ECG Interpretation Spotlight Interview Update: What Have We Learned? The Value of Educating Staff Events Calendar Industry News and Products Classifieds Advertisers Index In Memoriam

EP Lab Digest - March 2008

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