Conclusions
Lumenless leads have been available for many years and can be used for
traditional pacing applications as well as selective conduction system
pacing. Growth in conduction system pacing has led to increased
utilization of lumenless leads in recent years[17] . Potential
advantages of the lumenless lead include its small diameter, ease of
site-specific placement, and ease of extraction.
Figure 1. Design of cardiac implantable electronic device
leads. (a) typical coaxial pacemaker lead ( b) lumenless lead. The
lumenless lead has a flexible cable and an inner conductor surrounded by
insulators and a coiled outer conductor. The standard coaxial lead has a
lumen, contains no cable and is larger in diameter.
Figure 2. Implantation related injury current. Panel (a)
displays essentially no injury current and panel while (b) displays
desirable injury current.
Figure 3. His Bundle Pacing. Example of His bundle pacing, not
pacing artifact with isoelectric interval followed by narrow QRS
identical to sinus rhythm.
Figure 4. Left Bundle Branch Pacing. Example of pacing the left
sided conduction system, in this case the proximal left posterior
fascicle. This is evidenced by relatively narrow QRS, short LVAT, r’ in
V1, and left axis deviation.
Figure 5. CT Scan of 3830 lead position achieving left bundle
capture. Position of LB pacing lead. Axial CT scan image showing pacing
lead at mid septal position with tip approximating the LV endocardium
resulting in left bundle branch capture.
References
1. Cantu, F., et al., Selective-site pacing in paediatric
patients: a new application of the Select Secure system. Europace,
2009. 11 (5): p. 601-6.
2. Bharmanee, A., et al., Comparative Chronic Valve and Venous
Effects of Lumenless versus Stylet-Delivered Pacing Leads in Patients
with and Without Congenital Heart. Pacing & Clinical
Electrophysiology, 2015. 38 (11): p. 1343-50.
3. Gabbarini, F. and G. Agnoletti, Selective-site pacing in
paediatric patients: use of the SelectSecure System and risk of vein
occlusion. Europace, 2010. 12 (9): p. 1286-9.
4. Gammage, M.D., et al., Multi-center clinical experience with a
lumenless, catheter-delivered, bipolar, permanent pacemaker lead:
implant safety and electrical performance. Pacing & Clinical
Electrophysiology, 2006. 29 (8): p. 858-865.
5. Bansal, N., et al., Ten-Year Clinical Experience with the
Lumenless, Catheter-Delivered, 4.1-Fr Diameter Pacing Lead in Patients
with and without Congenital Heart. Pacing & Clinical
Electrophysiology, 2017. 40 (1): p. 17-25.
6. Lead EvaluAtion for Defibrillation and Reliability (LEADR) .
2021; Available from:
https://clinicaltrials.gov/ct2/show/NCT04863664.
7. El-Sherif, N., et al., Normalization of bundle branch block
patterns by distal His bundle pacing. Clinical and experimental evidence
of longitudinal dissociation in the pathologic his bundle. Circulation,
1978. 57 (3): p. 473-83.
8. Huang, W., et al., A beginner’s guide to permanent left bundle
branch pacing. Heart Rhythm, 2019. 16 (12): p. 1791-1796.
9. Ellenbogen, K.A. and P. Vijayaraman, His Bundle Pacing: A New
Promise in Heart Failure Therapy? JACC. Clinical Electrophysiology,
2015. 1 (6): p. 592-595.
10. SelectSecure MRI SureScan 3830: Technical Manual . 2018,
Medtronic Inc.
11. Krainski, F., et al., What goes in may need to come out:
Considerations in the extraction of a lumenless, fixed-screw permanent
pacemaker lead. Heart Rhythm O2, 2020. 1 (2): p. 160-163.
12. Jiang, Z., et al., Typical BBB morphology and implantation
depth of 3830 electrode predict QRS correction by left bundle branch
area pacing. Pacing & Clinical Electrophysiology, 2020.43 (1): p. 110-117.
13. Padala, S.K. and K.A. Ellenbogen, Left bundle branch pacing is
the best approach to physiological pacing. Heart Rhythm O2, 2020.1 (1): p. 59-67.
14. Vijayaraman, P., F.A. Subzposh, and A. Naperkowski, Extraction
of the permanent His bundle pacing lead: Safety outcomes and feasibility
of reimplantation. Heart Rhythm, 2019. 16 (8): p. 1196-1203.
15. Shepherd, E., et al., Extraction of SelectSecure leads
compared to conventional pacing leads in patients with congenital heart
disease and congenital atrioventricular block. Heart Rhythm, 2015.12 (6): p. 1227-32.
16. Cheng, A., et al., Novel approach to obtaining vascular access
in patients with abandoned endocardial pacemaker and ICD leads. Journal
of Cardiovascular Electrophysiology, 2007. 18 (3): p. 339-41.
17. Medtronic Product Performance Report. Issue 85, n.E. 2021.second .