EP Device Implant v2.3 Education-Lead Assessment

Video Transcription

Section H, Lead Assessment, will cover the new lead locations.  Lead location sequence 7735 will capture the location of all leads implanted in the patient during the current procedure.  The new locations highlighted in yellow were added to minimize the use of other, capturing the actual location of the lead.  The LV epicardial coronary venous system, CVS, is indicating a pacing or defibrillation lead was placed into the left ventricle through the coronary ostium into the coronary venous system, which has multiple branches, anterior, intraventricular, lateral, and mid-cardiac veins.  An epicardial pacing or defibrillation lead is implanted surgically on the outside of the cardiac muscle.  An epicardial lead can be implanted on the right atrium, right ventricle, or left ventricle.  Please capture a pacing or defibrillation lead placed at the location of the His bundle, which is implanted near the annulus of the tricuspid valve and distal to the AV node.  Please capture a pacing or defibrillation lead placed at the location of the Left bundle, which is implanted into the left ventricular septal subendocardium in the region of the Left bundle branch.  Please capture a pacing or defibrillation lead placed under the sternum. This system, which is part of a worldwide pivotal trial, was developed to address the limitations of the subcutaneous ICD. In addition to defibrillating, it can sense and pace.  Please capture a pacing or defibrillation lead placed in the azygous vein on the right side of the thorax. When electrode is located posterior to the heart in the azygous vein, the shock vector has been shown to better encompass the mass of the myocardium.  In patients with high defibrillation thresholds, the azygous vein lead placement is a safe option to lower thresholds. Did you know that the thresholds can increase over time due to changes in the myocardium and medications such as amiodarone? This occurs in 5-10% of implants.

Video Summary

This video transcript discusses various lead locations for pacing or defibrillation in patients. It highlights the new lead locations added to minimize the use of others and capture the actual location of the lead. It mentions the LV epicardial coronary venous system, where leads can be placed in multiple branches. It also talks about leads placed at the locations of the His bundle, Left bundle, under the sternum, and in the azygous vein. The system being discussed is part of a worldwide pivotal trial and can defibrillate, sense, and pace. The transcript also mentions that defibrillation thresholds can increase over time in some patients.

Keywords

patient evaluation

functional stress tests

anatomical imaging

NSTEMI

unstable angina

lead locations

LV epicardial coronary venous system

His bundle

sternum

azygous vein