Inadvertent transarterial insertion of atrial and ventricular defibrillator leads

Inadvertent placement of pacemaker and implantable cardioverter-defibrillator (ICD) leads in the left ventricle (LV) is a rare but well-recognized complication of device implantation [1]. We report a case of inadvertent transarterial implantation of dual-chamber ICD leads; the ventricular lead positioned in the LV and the atrial lead positioned in the aortic root. The tip of the atrial lead migrated across the aortic wall and captured the epicardial surface of the left atrium. The diagnosis was made 5 years after the implantation procedure with no apparent adverse events directly related to left heart lead placement.     

Interpreting device diagnostics for lead failure

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Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis

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将AVR导联作为常规多导心电图的节律导联在心律失常诊断中意义的探讨

目的探讨将aVR导联作为常规多导联心电图的节律导联在心律失常诊断中的价值。方法收集我院自2007年1月至2009年7月间收治心律失常患者1874例,均设置aVR导联为节律导联之一进行常规多导心电图检查,结合心内电生理检查结果进行对比分析,观察aVR导联在基本心律起源的诊断及各型心律失常的鉴别诊断中的作用。结果各型心律失常(各类早搏1119例,房颤并宽QRS波87例,室上速59例,宽QRS心动过速29例,各类逸搏273例,其他307例)均可由aVR导联记录并准确定位。结论将aVR导联替代II导联作为常规多导联心电图的节律导联用于分析基本心律起源和心律失常起源更合理。     

Rates and severity of perforation from implantable cardioverter-defibrillator leads: A 4-year study

INTRODUCTION: Although recent case reports and one small single-year observational study report a substantially increased rate of perforation with the St. Jude Riata series defibrillator lead, these results have not been externally validated. METHODS AND RESULTS: From 2004 to 2007, 593 implantable cardioverter-defibrillator (ICD) implants were performed by six faculty and 13 fellows at four University of California, San Francisco, CA, USA and affiliate hospitals. An electronic medical records system was systematically searched to identify clinically significant cases of ICD lead dislodgment or perforation. Of 307 (56%) St. Jude leads (all Riata series 6.3- and 7.3-French leads), 188 (29%) Medtronic leads (including 99 Sprint Fidelis 6.6 French leads), and 98 (15%) Guidant/Boston Scientific leads, there were three perforations in 593 cases (0.51%). One perforation occurred with a Medtronic Sprint Fidelis 6949 lead (0.53%), and two with a St. Jude Riata 1581 lead (0.65%). There were no statistically significant differences in perforation or dislodgement rates between manufacturers or lead models (p = NS for all). In both cases of perforation with the St. Jude Riata leads, the lead tip perforated through the pericardium into the pleural space. CONCLUSIONS: In our 4-year series of ICD implants, perforation and dislodgement rates were low, similar across all lead makes and models, and well below published and accepted complication rates. Our findings contradict previously-reported higher rates of perforation with the Riata lead. Registry and product performance reports should also classify complications by severity and outcome to provide a more complete assessment of product safety.     

Transvenous lead extraction in patients with systemic cardiac device–related infection—Procedural outcome and risk prediction: A GALLERY subgroup analysis

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Technical challenges and future directions in lead reconstruction for reduced-lead systems

Reduced-lead electrocardiographic systems are currently a widely accepted medical technology used in a number of applications. They provide increased patient comfort and superior performance in arrhythmia and ST monitoring. These systems have unique and compelling advantages over the traditional multichannel monitoring lead systems. However, the design and development of reduced-lead systems create numerous technical challenges. This article summarizes the major technical challenges commonly encountered in lead reconstruction for reduced-lead systems. We discuss the effects of basis lead and target lead selections, the differences between interpolated vs extrapolated leads, the database dependency of the coefficients, and the approaches in quantitative performance evaluation, and provide a comparison of different lead systems. In conclusion, existing reduced-lead systems differ significantly in regard to trade-offs from the technical, practical, and clinical points of view. Understanding the technical limitations, the strengths, and the trade-offs of these reduced-lead systems will hopefully guide future research.     

血管内反推力牵引术拔除感染性起搏电极导管

应用血管内反推力牵引术，经上腔静脉途径对９例病人的１４根感染性起搏电极导管进行拔除。１０根（７１．４％）电极导管被完全拔除，不完全拔除２根（１４．３％）。拔除失败的２根（１例）起搏电极导管经外科开胸术取出。平均随访９个月，感染被控制。提示血管内反推力牵引术是拔除感染性起搏电极导管和治疗起搏器植入术后顽固性感染的有效方法。     

Clinical performance of implantable cardioverter-defibrillator lead monitoring diagnostics

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Cardiovascular implantable electronic device lead safety: Harnessing real-world remote monitoring data for medical device evaluation

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