Abstract
Introduction: Cardiovascular implantable electronic device (CIEDs) are a proven therapy for the treatment of bradyarrhythmias, prevention of sudden death or heart failure. Since the first transvenous pacemaker implantation more than 60 years ago, technological advances in devices and improvements in surgical techniques have occurred. However, this type of therapy is still associated with significant complications, most of them related to the implantation of transvenous leads. Objective: To present a reflection on how to practice the rational use of lead implantation and propose strategies and alternatives to delay or avoid it, based on the current knowledge in the various fields of artificial cardiac stimulation. Methods: Review of literature that used articles from 1995 to 2019, from several platforms and periodicals. Conclusion: There is an expectation that in the coming years there will be technological and knowledge advances in the field of leadless stimulation, allowing these devices to be incorporated into clinical practice in a routine manner. Currently, if the implantation of ventricular electrodes in cases of sinus node disease with preserved atrioventricular conduction is rationalized, the implantation of atrial electrodes in implantable cardioverter-defibrillators (ICD) without the necessity of antibradicardia stimulation or ventricular electrodes in cases without the necessity of antitachycardia stimulation (ATP) considering the subcutaneous ICD implantation, this article will have fulfilled its role.
Highlights
Cardiovascular implantable electronic device (CIEDs) are a proven therapy for the treatment of bradyarrhythmias, prevention of sudden death or heart failure
Since the first transvenous pacemaker implantation more than 60 years ago, technological advances in devices and improvements in surgical techniques have occurred. This type of therapy is still associated with significant complications, most of which are related to the implant of transvenous leads: from venous access to implant site and structural problems leading to the main industry recalls[4,5,6,7]
The results of this study were very similar to the DANPACE study, but the authors concluded that AAIR pacing should be considered in selected patients with sinus node disease (SND) without AV block, since in 91.8% of the patients this mode of pacing is associated with lower costs, fewer electrodes and less right ventricular pacing; mainly because these pacemakers are being implanted in an increasingly older population, with a life expectancy limited due to other comorbidities[26]
Summary
Implantable electronic cardiac devices (CIEDs) are a proven therapy for the treatment of bradyarrhythmias, prevention of sudden death or heart failure. Since the first transvenous pacemaker implantation more than 60 years ago, technological advances in devices and improvements in surgical techniques have occurred. This type of therapy is still associated with significant complications, most of which are related to the implant of transvenous leads: from venous access to implant site and structural problems leading to the main industry recalls[4,5,6,7]. Leads will certainly present structural complications such as: insulator injury, conductor fracture or prohibitive impedance increases, which may put the patient at risk or exposure to extraction interventions that may be associated with significant morbidity and mortality . 18,19 Faced with this scenario, alternatives to minimize the number of electrodes implanted per patient are necessary
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