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 .