by Single-Chamber Pacing Leads
For single-chamber pacing of the right ventricle or right atrium, ventricular pacing leads or atrial pacing leads are used respectively. Ventricular pacing leads are thin insulated wires with a small electrode at the tip that is placed into either the right ventricle or right atrium through a vein. The Cardiac Pacing Leads. is then tunneled under the skin and connected to a pacemaker device that is usually implanted in the chest area. Atrial pacing leads are similar in design but placed into the upper chamber of the heart, the right atrium. Single-chamber leads provide pacing to one chamber of the heart to treat abnormalities in that specific chamber.
Dual-Chamber Pacing Leads
For dual-chamber pacing that stimulates both the right atrium and right ventricle in a synchronized manner, a ventricular lead and an atrial lead are used. This dual-chamber pacing maintains the natural timing relationship between the upper and lower chambers of the heart for more physiologic cardiac contractions. The atrial lead senses signals from the atrium and the ventricular lead provides stimulation pulses to the ventricle. Dual-chamber pacing is useful for treating conditions like atrioventricular block that affect both chambers of the heart.
Bipolar vs Unipolar Pacing Leads
Pacemaker Cardiac Pacing Leads can be either bipolar or unipolar in design. Unipolar pacing leads have a single electrode at the tip that both senses electrical signals and delivers stimulation pulses. The pacemaker casing acts as the return electrode to complete the electrical circuit. Bipolar leads on the other hand have two electrodes – the tip electrode provides stimulation and a ring electrode placed few centimeters proximal acts as the returning electrode to sense signals. Bipolar leads have better signal selectivity compared to unipolar leads by reducing skeletal muscle and ECG signal interference.
Cardiac Resynchronization Therapy (CRT) Leads
For patients with heart failure due to left ventricular dysfunction and intraventricular conduction delays, cardiac resynchronization therapy (CRT) can be beneficial. CRT uses three pacemaker leads – a right atrial lead, right ventricular lead and left ventricular (LV) lead placed through the coronary sinus vein into a side branch vein close to the LV. The LV lead delivers stimulation pulses to the left ventricle while the other two leads coordinate the right-sided pacing. CRT effectively resynchronizes ventricular contractions of both ventricles to improve heart function in heart failure patients.
Lead Placement Techniques
The most common technique to place pacemaker leads involves venous access through the subclavian vein which tunnel toward the heart and enter either the right atrium or ventricle. Alternatively, the cephalic vein cutdown or axillary vein access can also be used to deliver the leads depending on patient’s anatomy. Lead placement is performed by electrophysiologists under fluoroscopic guidance. The lead tip is maneuvered within the heart chambers and fixation mechanisms like passive or active tined leads are used to anchor it at the optimal pacing site. Placement of LV lead through transvenous routes requires advanced skills.
Complications of Lead Placemen
Though modern pacemaker lead implantation techniques have low complication rates, some risks remain. Risks during the procedure include venous injury, thrombosis, pneumothorax, cardiac perforation and problems with lead placement/fixation. Infection and lead dislodgement can occur post-procedure. Lead insulation breaks or impedance rise issues requiring lead surgery can also happen long-term. Experienced implanters and high volume centers are optimal for lead implantations to minimize risks through expertise and standardized techniques. Continuous improvements in lead design also help lower complication rates of this life-saving therapy.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
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