Initial clinical experience with a new self-retaining left ventricular lead for permanent left ventricular pacing.

This study evaluated the performance of a new lead for permanent left ventricular (LV) pacing via the coronary sinus (CS) in four men and nine women (mean age = 71 +/- 13 years) with sick sinus syndrome. It consists of a 75-cm-long, 4.8-Fr, unipolar ventricular lead with a distal portion preshaped in an S curve to provide steerability and stability within the CS. Its efficacy and stability for permanent LV pacing were tested at implant, predischarge, and at 1, 3 and 6 months of follow-up. The lead was successfully implanted in 11/13 patients (85%) within a mean fluoroscopy time of 35 +/- 22 minutes. The final positions of the electrodes at the tip of the lead within venous tributaries of the CS were: (1) anterior (n = 2, 18%); (2) posterolateral (n = 5, 45%); and (3) the lateral (n = 4, 36%). Unsuccessful implants were due to unstable lead position (n = 1), or high pacing threshold (n = 1). There was no postprocedural lead dislodgment or significant changes in the R wave amplitude, LV pacing threshold and lead impedance up to 6 months of follow-up. In summary, this initial experience suggests that this new lead offers safe and reliable permanent LV pacing via the CS in the majority of patients and may be used in isolation or in conjunction with right ventricular pacing for biventricular synchronization.