6533b855fe1ef96bd12afda2

RESEARCH PRODUCT

Active-fixation coronary sinus pacing lead extraction: A hybrid approach

subject

description

Cardiac resynchronization therapy (CRT) can be considered as the standard treatment for patients suffering from heart failure (NYHA III–IV), severely reduced left ventricular (LV) function, and wide QRS complexes. Over the past years, the lead systems used to stimulate the left ventricle have evolved technically from epicardial approaches to a transvenous access accompanied by a significant reduction of procedure-related complication rates [1]. However, even today, LV dislodgement rates ranging 5–10% and the instability of thresholds over time remain the greatest challenges with transvenous LV leads in CRT. Therefore, a special LV lead utilizing active fixation (the Attain StarFix® active fixation unipolar lead, Model 4195) was developed. At the target location, three lobes at the distal end of the lead can be deployed, which compress gently against the vein wall and thereby provide enhanced fixation of the LV lead [1]. This lead is safe and highly efficacious. It affords the physician more choices in lead placement location and has a remarkably low dislodgement rate [2,3]. We describe the case of a patient implanted in 2008 with a cardiac resynchronization therapy-defibrillator (CRT-D) device and an “active-fixation” coronary sinus lead (Attain StarFix®, Model 4195 Medtronic Inc., Minneapolis, MN, USA), who underwent transvenous lead