Nägele H, Azizi M, Hashagen S, Castel M A, Behrens S
Medical Department, St Adolfstift, Hamburgerstr. 41, D-21465 Reinbek, Germany.
Europace. 2007 Jun;9(6):437-41. doi: 10.1093/europace/eum061. Epub 2007 Apr 21.
Coronary sinus (CS) lead implantation is a technically challenging procedure owing to variable vein anatomies and a high dislocation rate. Therefore, CS lead technology has undergone evolutionary changes during the last 10 years. The mode of fixation has been a passive one up to now. We want to describe our first clinical experience with the newly available active fixation lead 4195 in terms of dislocation rate and stability of thresholds compared with conventional models.
From 1999 to February 2007, we implanted 403 CS leads in 368 patients. Leads were categorized into three different groups on the basis of their fixation mechanism: straight (Easytrak I and Situs OTW; n = 54), curved (Attain 4193 and 4194, Corox, Aescula, Situs ULD; n = 308), and active (Attain 4195; n = 41). Operative and follow-up data were prospectively noted and checked for significance between groups during the first 3 months after implantation. Kaplan-Meier analysis of long-term lead function was also performed. Straight and curved CS leads suffered from significantly more dislocations compared with active fixation (P < 0.001). The active fixation lead (4195) has a stable threshold over time compared with a significant rise after 24 h and thereafter in straight (62%) and curved leads (20%). However, retraction of an active fixation CS lead may be a difficult issue as outlined in two cases requiring pullback of a 4195 lead owing to phrenic nerve stimulation (one unsuccessful despite vigorous traction).
The active fixation lead 4195 using retention lobes yielded stable thresholds over time and seems to be superior to conventional leads in terms of dislocation. However, extraction may be a difficult or even impossible task.
由于冠状静脉窦（CS）的静脉解剖结构多变且脱位率高，CS导联植入术在技术上具有挑战性。因此，在过去10年中，CS导联技术经历了不断的演变。到目前为止，固定方式一直是被动式的。我们希望描述我们首次使用新型主动固定导联4195的临床经验，包括与传统型号相比其脱位率和阈值稳定性。
从1999年至2007年2月，我们在368例患者中植入了403根CS导联。根据其固定机制，导联被分为三个不同的组：直型（Easytrak I和Situs OTW；n = 54）、弯型（Attain 4193和4194、Corox、Aescula、Situs ULD；n = 308）和主动型（Attain 4195；n = 41）。前瞻性记录手术和随访数据，并在植入后的前3个月检查组间的显著性。还对导联长期功能进行了Kaplan-Meier分析。与主动固定相比，直型和弯型CS导联脱位明显更多（P < 0.001）。与直型（62%）和弯型导联（20%）在24小时及之后阈值显著升高相比，主动固定导联（4195）随时间阈值稳定。然而，如两例因膈神经刺激需要回撤4195导联（其中一例尽管大力牵引仍未成功）所示那样，主动固定CS导联的回撤可能是个难题。
使用固定叶的主动固定导联4195随时间产生稳定的阈值，并且在脱位方面似乎优于传统导联。然而，拔除可能是一项困难甚至不可能的任务。
