Usefulness of a pacing guidewire to facilitate left ventricular lead implantation in cardiac resynchronization therapy.

BACKGROUND

Intraoperative measurements of left ventricular (LV) pacing and sensing values were assessed using a novel 0.014-inch guidewire (Visionwire, Biotronik GmbH, Berlin, Germany) enabling pacing and sensing at the distal tip before final LV lead implantation.

METHODS

Twenty-two consecutive patients selected for cardiac resynchronization therapy were studied.

RESULTS

Significant correlation was found between the LV pacing threshold as assessed by the Visionwire and values after final LV lead implantation (r = 0.92, P < 0.001). Correlation for LV sensing was also significant (r = 0.72, P < 0.001). No significant correlation was present with respect to phrenic nerve stimulation. However, no phrenic nerve stimulation at 10 V/0.5 ms using the Visionwire identified 88% of patients without phrenic nerve stimulation at 10 V/0.5 ms with subsequent LV lead measurements.

CONCLUSION

This technique may facilitate transvenous LV lead implantation by preventing implantation in a unsuitable target vessel with respect to pacing and sensing values or phrenic nerve stimulation, thereby reducing procedure and fluoroscopy time.