14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-50

Four chamber pacing: a single lead placed into the coronary sinus, supported by a stent. Acute experimental investigation

Leonardo Cammilli, Avio Maria Perna, Gino Grassi, Francesco Cammilli, Antonio Morra, Federico Perna.
Cardiac Surgery Lab, USL 10D, Firenze, Italy

Introduction

Since five years a new philosophy concerning the treatment of atrial fibrillation, dilated cardiomyopathy and congestive heart failure was postulated.

Four chamber pacing (FCP), or anyway multi site pacing (MSP) are the foreseen goals.

At present some problems have to be solved to obtain a better FCP.

In fact problems related to FCP could be so summarized:

a) necessity of several leads;

b) no stability of the electrodes introduced into the coronary sinus (CS) to pace LA and LV;

c) complex procedures contrived to decrease such electrodes unstableness.

In the figure 1 quantity and placement into cardiac cavities and/or CS of the leads, in clinical trials against dilated cardiomyopathy are drawn. Such drawings are related to FCP and MSP experienced by Cazeau¹, Daubert², Barin³.

Fig. 1: This figure represents, in schematic way, the present clinical application of multi site pacing as therapy for dilated cardiomyopathy and experimental attempts performed by our work group to reduce at a single lead the way to reach the four chambers.

In the figure 2 quantity and placement into the cardiac cavities and/or into the CS of the leads in clinical trials to prevent recurrent AF, are drawn. Such drawings, related to FCP and MSP concern clinical trials experienced by Daubert⁴, Saksena⁵, Bailin⁶ and Spencer⁷.

Fig. 2: This figure represents schematically the present clinical application of multi site pacing as therapy to decrease the recurrence of AF. Our proposal to obtain a four chamber pacing by means of a single lead supported by a Nitinol stent, is drawn.

To these drawings concerning clinical trials the schemas of our experimental investigations are added.

In fact in experimental investigation performed in the last two years, a new way to solve the previous problems concerning the leads, both for dilated cardiomyopathy and atrial fibrillation was tested.

The aim of lour last studies is to propose a totally new rationale concerning this very recent field.