vendex and Cardiomyopathies

Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the Netherlands) has shown promising results. We share our initial experience with this novel active fixation LV lead.. A Medtronic active fixation lead 20066 was used in eight consecutive patients for CRT. An optimal site was chosen and recommended maneuvers were applied for lead fixation. Push and pull maneuvers were used to test stability.. There were two initial dislodgements after which we used a transvalvular insertion (TVI) tool that was used in the hemostatic valve during rotation of the lead so that the torque was easily transmitted to the tip. It also allowed better tactile feedback during push-pull tests. There were no further dislodgements in the subsequent six patients. However, in one patient the lead could not be unscrewed due to the tip getting wedged at a distal smaller vein. Repositioning of the LV lead was done in three patients due to PNS or pacing issues. The median time for LV lead placement was 16.5 minutes (interquartile range 9-25 minutes).. The Medtronic Attain Stability 20066 active fixation LV lead can potentially be implanted at any pacing site avoiding PNS and providing better stability. The learning curve is short and additional tricks can be learnt to improve success. Use of TVI while the lead is rotated is beneficial.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Resynchronization Therapy Devices; Cardiomyopathies; Electrodes, Implanted; Equipment Failure Analysis; Female; Heart Block; Heart Ventricles; Humans; Male; Middle Aged; Netherlands; Phrenic Nerve; Rotation; Torque

Electrical myostimulation (EMS) has recently been proposed as an interesting rehabilitation tool in patients with chronic heart failure (CHF). Although its beneficial effects on exercise capacity and muscle strength have been demonstrated, the neuromuscular adaptations responsible for improved performance are not well understood. This preliminary case report was therefore planned to investigate the neural and muscular adaptations to a 5-wk EMS program in one patient. An increase in maximal strength (10.5%) was accompanied by increased twitch torque (13.9%) and slowing of muscle contractile properties (half-relaxation time, time to peak torque, and maximal rate of relaxation increased by 7.1, 31.1, and 16.6%, respectively) without changes in muscle activation. This preliminary case report therefore shows that in a highly deconditioned patient, EMS training improved strength through muscular adaptations rather than by neural changes, suggesting that EMS may be valuable for counterbalancing loss of muscle strength and function common in CHF patients.

Topics: Adaptation, Physiological; Cardiomyopathies; Electric Stimulation; Electromyography; Feasibility Studies; Heart; Heart Failure; Humans; Leg; Male; Middle Aged; Muscle, Skeletal; Myocardial Contraction; Stroke Volume; Torque