Andrzej Kutarski, Max Schaldach*, Maciej Wójcik, Krzysztof Oleszczak, Krzysztof Poleszak, Teresa Widomska-Czekajska.
Department of Cardiology, Medical University Academy, Lublin, Poland, *Department of Biomedical Engineering, University of Erlangen-Nuremberg, Germany
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Coronary sinus (CS) plays more and more important role as a place for
permanent atrial pacing/sensing recently. Since 1968, when Moss as the first one implanted standard lead to CS for
atrial pacing1 several investigators described problems of CS permanent
pacing2-14 Lead dislodgement was observed
in: 8-9%2,10, 12%7,8,
and 13-14%4,5 of pts. Reoperation due to exit block was described in
0-2%8,10, 5-6%2,5,
14-16%3,4
and the differences are easy to understand if is remembered that earlier experiences were obtained in
non-programmable pacemaker area.
CS was paced with standard (usually straight BP) leads1-3,7-11.
Since 1973 utility2,3 of special CS leads was began
(with additional inactive flexible tip)3. In early 90
Daubert tried CS pacing using standard “J” shaped leads4. Excellent
pacing conditions were noted (PTh below 1.6 V) but dislodgement frequency was very high -
16%4. The observations
were effected the new one “shape concept” of CS lead fixation: tip pacing and special lead shape (double 45°
angulation of the distal part of lead) and Medtronic SP 2188 CS lead construction5. Earlier experience showed
excellent pacing / sensing effectiveness but lead dislodgement remained still frequent - 13%5. Our experience with
left atrium (LA) pacing using standard leads9-11, indicated that LA can be paced from ring electrode of standard lead
and its inactive tip with tines can play important anchoring role5. It
provided to construction of special lead designed
for CS pacing and first experience were very promising12,13. The aim of this study was long term evaluation of
usefulness of this lead for LA pacing in different pacing system.
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