Regions Hospital, St. Paul, MN 55101, USA.
HealthPartners Medical Group, Bloomington, MN, USA.
Europace. 2017 Dec 1;19(12):2007-2014. doi: 10.1093/europace/euw311.
In patients with a functional Sprint Fidelis lead at generator replacement, the manufacturer recommended to either continue to use the existing lead or replace it with a new lead. For those patients who continue to use a functional Fidelis lead, the risk of inappropriate shocks remains present if the lead fails in the future. We evaluated the feasibility of an alternative approach at the time of cardiac resynchronization therapy-defibrillator (CRT-D) generator replacement in patients with a functional bipolar left ventricular (LV) lead for prevention of inappropriate shocks from future Fidelis lead failure.
During the procedure, the pace/sense IS-1 connection pin of the functional Fidelis lead was intentionally inserted into the LV port of the new CRT-D generator, while the existing bipolar LV lead IS-1 connection pin was inserted into the right ventricular (RV) pace/sense port. After such switching, the existing bipolar LV lead was used for functional LV pacing/sensing, while the Fidelis lead was used for functional RV pacing and high voltage shock only and could no longer be used for the purpose of sensing and detecting. This approach precluded oversensing and inappropriate shocks should the functional Fidelis lead fail in the future. Six fragile patients, who were not considered suitable candidates for lead replacement, underwent the alternative approach. During a follow-up of 35 ± 23 months, the CRT-D system functioned normally in five patients. The Fidelis lead fractured in one patient 7 months after generator replacement. The malfunction was detected promptly and the defected lead was replaced. No inappropriate detections or shock was triggered.
In CRT-D patients with a functional Fidelis lead and a bipolar LV lead, switching of the Fidelis lead pace/sense IS-1 pin with the bipolar LV lead IS-1 pin at generator replacement did not affect normal system function. This novel approach may be valuable in fragile patients with high risk of sudden death for prevention of inappropriate shocks triggered by oversensing from a malfunctioning Fidelis lead.
在更换带有功能性 Sprint Fidelis 导联的发生器的患者中，制造商建议要么继续使用现有的导联，要么更换新的导联。对于那些继续使用功能性 Fidelis 导联的患者，如果导联将来出现故障，仍然存在不适当电击的风险。我们评估了在功能性双极左心室（LV）导联的心脏再同步治疗除颤器（CRT-D）发生器更换时的替代方法的可行性，以防止未来 Fidelis 导联故障引起不适当的电击。
在手术过程中，将功能性 Fidelis 导联的起搏/感知 IS-1 连接销故意插入新 CRT-D 发生器的 LV 端口，同时将现有的双极 LV 导联 IS-1 连接销插入右心室（RV）起搏/感知端口。进行这种切换后，现有的双极 LV 导联用于功能性 LV 起搏/感知，而 Fidelis 导联仅用于功能性 RV 起搏和高压电击，并且不能再用于感知和检测目的。这种方法可以防止功能性 Fidelis 导联出现故障时出现过感知和不适当的电击。六名脆弱患者因不适合进行导联更换而接受了替代方法。在 35±23 个月的随访中，五名患者的 CRT-D 系统功能正常。一名患者在更换发生器 7 个月后 Fidelis 导联断裂。及时发现故障并更换了有缺陷的导联。没有触发不适当的检测或电击。
在具有功能性 Fidelis 导联和双极 LV 导联的 CRT-D 患者中，在更换发生器时将 Fidelis 导联起搏/感知 IS-1 销与双极 LV 导联 IS-1 销进行切换不会影响正常系统功能。对于有高猝死风险的脆弱患者，这种新方法可能具有重要价值，可以防止因 Fidelis 导联故障引起的过感知触发不适当的电击。
