An ergonomic guide catheter slitting technique designed to avoid lead dislodgement

Abstract

Guide catheters help deliver endocardial leads to specific locations within the heart, but their disengagement afterwards can be challenging. Slitting the catheter open over the lead may require the creation of an artificial platform to provide support for the blade and cause lead dislodgement through a sideways drag on the catheter by the hand pulling it or a forward push by the hand holding the blade. An alternative ergonomic technique addressing these shortcomings was developed. The ipsilateral elbow presses against the iliac fossa or anterior superior iliac spine to support the hand holding the blade. The other hand pulls the catheter in small steps with constant adjustments of the direction of pull and the angle of the blade to ensure alignment of the different parts. If necessary, the hand pulling the catheter will drop it to reduce any loop in the catheter segment between the blade and the exit site of the catheter from the patient's body. The technique was tried on all guide catheters which required slitting during cardiac rhythm device procedures by a single operator. Thirty-two guide catheters from different manufacturers were successfully slit without dislodging any leads. The leads might slide forward into the heart during catheter slitting but their positions could all be adjusted by pulling them back afterwards. The ergonomic slitting technique should facilitate the use of guide catheters for positioning endocardial leads by reducing the risk of lead dislodgement. It proved useful and successful when applied to guide catheters from different manufacturers. Its general utility needs to be assessed in a wider clinical setting.