Passive Fixation Research Articles

Perforación cardiaca posterior al implante de marcapasos: reporte de caso y revisión de la literatura

Cardiac perforation after implanting a pacemaker with active or passive fixation is an uncommon presentation pathology and with high mortality rates. In a series of 2,200 patients who received a transvenous pacemaker, the incidence of cardiac perforation was 0.8%, however, there are reports with statistics that exceed considerably when using pacemakers with active fixation leads. The clinical presentation is highly variable, precordial pain is the most frequent symptom and up to 15% of the patients can be asymptomatic, identifying the perforation only the computed tomography of control, making this complication a timely diagnostic challenge in some cases.In this article, we make a contribution to the world literature of a cardiac perforation secondary to the use of an Implantable Cardioverter Defibrillator (ICD) and systematic review of the current literature on this topic along with its most important aspects in order to give a feedback to people involved in this subject.

Simple and Rapid Tissue Clearing Method for Three-Dimensional Histology of the Pancreas.

Previously, high-resolution three-dimensional imaging of a whole and intact pancreas was not possible, since light is scattered when it passes through cell compartments with different refractive indices. CLARITY is one of the tissue clearing techniques that has yielded success with the central nervous system. To preserve tissue integrity after delipidation, conventional protocols embed tissue in an acrylamide-based hydrogel, which involves the use of specialized equipment. Recently, we determined that the hydrogel-embedding step could be simplified and replaced by passive tissue fixation in 4% paraformaldehyde (PFA). The whole procedure is less time-consuming and less error-prone, and can be completed within a week, compared to conventional CLARITY protocols that may take weeks to complete. Here, the detailed stepwise procedures involved in the simplified CLARITY workflow are applied to the pancreas of wild-type and gene-knockout 6-week old mice expressing green fluorescent protein (GFP) under the mouse insulin 1 promoter (MIP-GFP). This technique could facilitate high-resolution, three-dimensional imaging of pancreatic islets and comparison between different mouse genotypes under different disease and treatment conditions. © 2017 by John Wiley & Sons, Inc.

Decoupled choice-driven and stimulus-related activity in parietal neurons may be misrepresented by choice probabilities

Trial-by-trial correlations between neural responses and choices (choice probabilities) are often interpreted to reflect a causal contribution of neurons to task performance. However, choice probabilities may arise from top-down, rather than bottom-up, signals. We isolated distinct sensory and decision contributions to single-unit activity recorded from the dorsal medial superior temporal (MSTd) and ventral intraparietal (VIP) areas of monkeys during perception of self-motion. Superficially, neurons in both areas show similar tuning curves during task performance. However, tuning in MSTd neurons primarily reflects sensory inputs, whereas choice-related signals dominate tuning in VIP neurons. Importantly, the choice-related activity of VIP neurons is not predictable from their stimulus tuning, and these factors are often confounded in choice probability measurements. This finding was confirmed in a subset of neurons for which stimulus tuning was measured during passive fixation. Our findings reveal decoupled stimulus and choice signals in the VIP area, and challenge our understanding of choice signals in the brain.

Safety and effectiveness of a 6-French MRI conditional pacemaker lead: The INGEVITYTM clinical investigation study results.

The design of pacemaker leads has continued to evolve; ease of lead handling, improved electrical performance, and magnetic resonance imaging (MRI) conditional aspects have become more important, while safety remains critical. The INGEVITY™ family leads was designed to provide MRI conditional aspects, decreased diameter, and improved performance of pacemaker leads. The INGEVITY study is an investigational device exemption trial evaluating the acute and chronic safety and effectiveness of these leads. Consecutive patients were included in 77 institutions worldwide, where 1,657 leads (846 right ventricular active fixation leads, 213 right ventricular passive fixation leads, 121 right atrial passive fixation preformed J-leads, and 477 right atrial active fixation leads) were implanted or attempted in 1,060 subjects. At 3-month follow-up, the electrical performance were: mean pacing threshold 0.67 V at 0.5-ms pulse width, pacing impedance 773 ohms, mean P-wave amplitude 4.8mV, and R-wave amplitude 16.5 ± 6.5mV. Over a median follow-up of 31 months, 93 subjects died and 33 subjects reported lead-related complications. Lead-related complication-free rate from 0 to 3 months and 3 to 12 months for all leads was 98.4% and 99.7%, respectively. The hazard of lead-related complications was observed to be decelerating over the course of follow-up (Weibull shape=0.23). The overall lead dislodgment rate observed in the study was 1.3%, the perforation rate was 0.0%, and the pericardial effusion rate was 0.3%. The clinical performance of the INGEVITY lead demonstrated a high lead-related complication-free rate over 12 months of follow-up and excellent electrical characteristics.

Single-center experience with percutaneous lead extraction of cardiac implantable electric devices

BackgroundThe estimated incidence of infected cardiac implantable electric devices (CIED) has recently increased to 1–2% in Japan. Extraction of long-term implanted devices is generally difficult. There are few reports about lead extraction in Japan. We describe our experience with and outcomes of lead extraction using excimer lasers, mechanical sheaths, and manual extraction. MethodsWe retrospectively analyzed the characteristics, types of devices, and indications for extraction in 29 patients with 67 leads who required CIED lead extraction at Shinshu University Hospital between April 2014 and October 2016. Mean patient age was 71 years and 25 patients were male. The indications for device extraction were infections (n=25) and non-functioning leads (n=4). ResultsA total of 67 leads (active fixation lead, n=28; passive fixation lead, n=39) had been implanted for a median duration of 6.3±5.6 years. Extractions were performed using an excimer laser sheath (n=26), laser with mechanical sheath (n=7), only mechanical sheath (Cook Vascular Inc., Leechburg, PA, USA) (n=1), and manually (n=1). The procedure was successful in all patients. There were no major or minor complications during extraction. There was no recurrence of infection after infected device extraction. Two patients were implanted with subcutaneous implantable defibrillators after extraction of the implantable cardioverter defibrillator (ICD). ConclusionsCIED lead extraction, especially of those that are adherent to the subclavian vein, can be successfully performed in Japanese subjects using an excimer laser and mechanical sheath, without complications.

P3377Bipolar active fixation left ventricular lead or quadripolar passive fixation lead? Results of an Italian multicenter experience

P3377Bipolar active fixation left ventricular lead or quadripolar passive fixation lead? Results of an Italian multicenter experience

P1001Active fixation left ventricular lead or passive fixation quadripolar lead? Results of an Italian multicenter experience

P1001Active fixation left ventricular lead or passive fixation quadripolar lead? Results of an Italian multicenter experience

P984Minimal invasive right atrial pacemaker lead repositioning with passive fixation leads

P984Minimal invasive right atrial pacemaker lead repositioning with passive fixation leads

Antiarrhythmic properties of atrial pacing.

Bradycardia, atrial stretch and dilatation, autonomic nervous system disorders, and the presence of triggers such as atrial premature contractions, are factors which predispose a person to paroxysmal AF. Atrial pacing not only eliminates bradycardia but also prevents atrial premature contractions and dispersion of refractoriness, which are a substrate for atrial fibrillation. As the prolonged duration of atrial activation during pacing, especially from locations changing the physiological pattern of this activation (right atrium lateral wall, right atrium appendage), negatively influences both a mechanical and an electrical function of the atria, the atrial pacing site affects an atrial arrhythmogenesis. A conventional atrial lead location in the right atrium appendage causes non-physiological activation propagation, resulting in a prolongation of the activation time of both atria. This location is optimal according to a passive fixation of the atrial lead but the available contemporary active fixation leads could potentially be located in any area of the atrium. There is growing evidence of the benefit of pacing, imitating the physiological propagation of impulses within the atria. It seems that the Bachmann's bundle pacing is the best pacing site within the atria, not only positively influencing the atrial mechanical function but also best fulfilling the so-called atrial resynchronization function, in particular in patients with interatrial conduction delay. It can be effectively achieved using only one atrial electrode, and the slight shortening of atrioventricular conduction provides an additional benefit of this atrial pacing site.

Lead Extraction of Cardiac Rhythm Devices: A Report of a Single-Center Experience.

The rate of implanted cardiac electronic devices is increasing as is the need to manage long-term complications. Lead removal is becoming an effective approach to treat such complications. We present our experience in lead removal using different approaches, analyzing the predictors of the use of mechanical extractors/surgical removal. Retrospective analysis of lead extractions in a series of 76 consecutive patients (mean age 70.4 ± 13.8 years, 73.7% men) between January 2009 and November 2015. One hundred thirty-five leads from permanent pacemakers (single chamber 19.7%; dual-chamber 61.8%), implantable cardioverter defibrillators (5.3%), and cardiac resynchronization devices (CRT-P 2.6%; CRT-D 7.9%) were removed, 72.5 ± 73.2 months after implantation. A total of 45.9% were ventricular leads, 40.0% atrial leads, 8.9% defibrillator leads, and 5.2% leads in the coronary sinus; 64.4% had passive fixation. The most common indications for removal were pocket infection (77.8%), infective endocarditis (9.6%), and lead dislodgement (3.7%). A total of 76.3% of the leads were explanted, 20.0% were extracted, and 3.7% were surgically removed. Extraction of the entire lead was achieved in 96.3% of the procedures. After logistic regression (age adjusted), time since implantation was the sole predictor of the need of mechanical extractors/surgical removal. All patients were discharged without major complications. There were no deaths at 30 days. Our experience in lead removal was effective and safe. Performing these procedures by experienced electrophysiologists with an adequate cardiothoracic surgery team on standby to cope with any complications is required. Referral of high-risk patients to a high-volume center is recommended to optimize clinical success and minimize procedural complications.

Minimal invasive right ventricular and atrial pacemaker lead repositioning as a first alternative is superior in avoiding pocket complications with passive fixation leads.

Lead dislocations of pacemaker systems are reported in all and even in high-volume centers. Repeated procedures necessitated by lead dislocations are associated with an increased risk of complications. We investigated a minimal invasive method for right atrial and ventricular lead repositioning. The minimal invasive method was applied only when passive fixation leads were implanted. During the minimal invasive procedure, a steerable catheter was advanced through the femoral vein to move the distal end of the lead to the appropriate position. Retrospective data collection was conducted in all patients with minimal invasive and with conventional method, at a single center between September 2006 and December 2012. Forty-five minimal invasive lead repositionings were performed, of which eight were acutely unsuccessful and nine electrodes re-dislocated after the procedure. One hundred two leads were repositioned with opening of the pocket during the same time, including the ones with unsuccessful minimal invasive repositionings. One procedure was acutely unsuccessful in this group and four re-dislocations happened. A significant difference of success rates was noted (66.6% vs. 95.1%, p=0.001). One complication was observed during the minimal invasive lead repositionings (left ventricular lead microdislodgement). Open-pocket procedures showed different types of complications (pneumothorax, subclavian artery puncture, pericardial effusion, hematoma, fever, device-associated infection which necessitated explantation, atrial lead dislodgement while repositioning the ventricular one, deterioration of renal function). The minimal invasive method as a first alternative is safe and feasible. In those cases when it cannot be carried out successfully, the conventional method is applicable.

A comparative analysis of the effectiveness of active versus passive atrial lead fixation in Chinese patients with cardiac implantable electrical devices: a long term, retrospective, observational, single-center study

Background: Data comparing active atrial lead fixation with passive atrial lead fixation in Chinese patients with cardiovascular implantable electronic devices (CIEDs) for atrial pacing is limited. Our study evaluated the effectiveness of active fixation versus passive fixation of atrial leads by observing the lead performance parameters.Methods: This retrospective, long-term, single-center study included a cohort of Chinese patients who underwent CIED implantation at the Department of Cardiology of People’s Hospital of Yuxi City, China, from 1 March 2010 to 1 March 2015. Efficacy was determined by comparing implantation time, threshold values, incidence of lead dislocation/failure, and lead-related complications between the two groups.Results: Of the 1217 patients, active and passive atrial lead fixation were performed in 530 (mean age, 69.37 ± 11.44 years) and 497 (mean age, 68.33 ± 10.96 years). The active fixation group reported significantly lower mean atrial implantation times (P = .0001) and threshold values (P = .044) compared with the passive atrial lead fixation group. In addition, threshold values in the active atrial lead fixation group were stable throughout the observation period. No instances of myocardial perforation, cardiac tamponade, implantation failure, or electrode dislocation/re-fixation were reported in the active atrial lead fixation group. A favorable decrease in patient comfort parameters such as bed rest time (P = .027) and duration of hospital stay (P = .038) were also observed in the active lead fixation group.Conclusion: Active atrial lead fixation demonstrated greater stability, steady long-term thresholds and minimal lead-related complications compared to passive lead fixation in Chinese patients with CIEDs.

Coding of viewpoint, posture and identity of bodies in the macaque midSTS body patch.

Event Abstract Back to Event Coding of viewpoint, posture and identity of bodies in the macaque midSTS body patch. Satwant Kumar1* and Rufin Vogels1* 1 KU Leuven, Dept. of Neurosciences, Belgium FMRI studies in primates show body-category selective activations in temporal cortex. Single unit studies in the midSTS body patch revealed greater activity to images containing bodies compared to faces and objects. However, these neurons showed a marked body image selectivity, responding only to some body images. The body image selectivity may reflect encoding of body identity, posture and viewpoint. Here we examined the selectivity of the fMRI-defined macaque midSTS body patch neurons for these three variables. We designed a novel computer-generated stimulus set (n= 120 stimuli) depicting monkeys that differ in anthropometric features (identity; fat, normal and thin), with 5 different postures (2 threat, 2 submissive and 1 neutral posture), rendered at 8 viewpoints (45 deg step; rotated around the vertical axis). The internal facial features of the head were removed. The images were presented for 200 ms each during passive fixation in 2 rhesus male monkeys. Single unit recordings showed a marked selectivity for viewpoint and posture. We employed linear SVM with cross-validation to decode viewpoint, posture and identity from the responses of 88 midSTS neurons. First we asked whether we could decode one variable (e.g. viewpoint) when varying the two other variables (e.g. posture and identity). Decoding of identity and posture invariant viewpoint (classification accuracy: 73%; 200 ms binwidth; chance level : 12.5%) and viewpoint and identity invariant posture (50%; chance level: 20%) was well above chance (permutation test with shuffled stimulus labels; p < 0.005) but viewpoint and posture invariant identity decoding (36%) was barely above chance level (33%; p = 0.04). However, it was possible to decode identity for particular view and posture combinations (accuracy ranging between 57 and 95%; chance = 33%). Second, we asked how tolerant the decoding of one variable is for changes of the other variables by training e.g. viewpoint decoding at one particular identity and posture and testing at the same and other combinations of the latter two variables. This analysis revealed little generalization of posture and identity decoding with viewpoint, in line with the viewpoint selectivity of midSTS body patch neurons. Posture and viewpoint decoding generalized well across identities. Analysis of the viewpoint-dependent errors in pose encoding suggested an encoding of head orientation by these body patch neurons. Viewpoint decoding generalized across the threat but not across the other postures. These data suggest that the output of midSTS body patch neurons are useful to decode the posture and orientation of bodies, with a role of head orientation. Keywords: macaque, body patch, Electrophysiology, Neural Encoding, Identity, viewpoint invariance, viewpoint generalization, Posture Conference: 12th National Congress of the Belgian Society for Neuroscience, Gent, Belgium, 22 May - 22 May, 2017. Presentation Type: Poster Presentation Topic: Sensory and Motor Systems Citation: Kumar S and Vogels R (2019). Coding of viewpoint, posture and identity of bodies in the macaque midSTS body patch.. Front. Neurosci. Conference Abstract: 12th National Congress of the Belgian Society for Neuroscience. doi: 10.3389/conf.fnins.2017.94.00055 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 24 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Mr. Satwant Kumar, KU Leuven, Dept. of Neurosciences, LEUVEN, 3000, Belgium, satwant.dagar@gmail.com Prof. Rufin Vogels, KU Leuven, Dept. of Neurosciences, LEUVEN, 3000, Belgium, rufin.vogels@kuleuven.be Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Satwant Kumar Rufin Vogels Google Satwant Kumar Rufin Vogels Google Scholar Satwant Kumar Rufin Vogels PubMed Satwant Kumar Rufin Vogels Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Late Fragmentation of Coronary Sinus Lead and Perforation with Retained Guide Wire after Cardiac Resynchronization Therapy

Passive fixation of coronary sinus leads is an imperfect technique with a high incidence of intraoperative and post-operative dislocations. The retained guide wire technique has been proposed for stabilizing the left ventricular lead. Long term effects of retained guide wire on lead parameters are unknown. We describe two cases in which guide wire was retained in coronary sinus lead because of recurrent intraoperative lead dislocations. Both patients at 9-12 months of followup showed marked rise in left ventricular lead impedance with loss of capture. Fluoroscopy revealed multiple sites of lead fragmentation. The retained guide wire causes lead degradation and should be removed.

Functional coupling between frontoparietal and occipitotemporal pathways during action and perception

Several lines of evidence point to areas in the occipitotemporal pathway as being critical in the processes of visual perception and object recognition. Much less appreciated, however, is the role that this pathway plays in object-related processing for the purposes of visually guided action. Here, using functional MRI (fMRI) and functional connectivity (FC) measures, we examined interactions between areas in frontoparietal cortex (FPC) involved in grasping, reaching, eye movements, and tool use and areas in occipitotemporal cortex (OTC) involved in object-, face-, scene-, body-, tool-, and motion-related processing, both during the performance of sensorimotor and visual-perceptual tasks, as well as during passive fixation (resting-state). Cluster analysis of regional time course data identified correspondence in the patterns of FPC and OTC connectivity during the visual-perceptual tasks and rest that both tended to segregate regions along traditional dorsal/ventral pathway boundaries. During the sensorimotor tasks, however, we observed a notable separation in functional coupling between ventral-medial and ventral-lateral regions of OTC, with several of the latter areas often being clustered together with sensorimotor-defined areas in parietal cortex. These findings indicate that the functional coupling of ventral-lateral OTC areas to dorsal parietal and ventral-medial structures is flexible and task-dependent, and suggests that regions in lateral occipital cortex, in particular, may play an important role in mediating interactions between the dorsal and ventral pathways during tasks involving sensorimotor control.

Canadian Registry of Implantable Electronic Device Outcomes: Surveillance of the Riata Lead Under Advisory.

The Riata lead under advisory has posed a unique clinical scenario where inside-out abrasion results in externalization of conductor cables, with a higher risk of electrical failure. We developed a comprehensive registry to assist with clinical management of this lead. This Canadian registry reports the findings of 3763 (74.2% of all Riata leads in Canada) Riata leads under advisory, with a mean follow-up time of 8.9±1.5 years. The overall electrical failure rate was 5.2% at 8 years, with no difference between 7-French and 8-French lead models. Cable externalization was found to be more common in the 8-French model (12.3% versus 5.2%, P<0.0001) and was associated with a higher risk of electrical failure. Predictors of electrical lead failure included cable externalization, higher left ventricular ejection fraction, younger age, higher body mass index, and a passive fixation lead. One patient died due to electrical failure, a further 2 patients survived an event where the device failed to deliver high-voltage therapy. Major complications because of lead extraction were higher when compared with lead abandonment, no difference among lead model observed. Two deaths occurred as a consequence of lead extraction, in the context of an underlying infection. The Riata lead under advisory has a steady electrical failure rate over time. There are identifiable predictors of lead failure that can assist with clinical decisions as to whether lead revision should be performed prophylactically.

Right atrial lead fixation type and lead position are associated with significant variation in complications.

Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms. All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1year by chi-square analysis and at 5years using a Kaplan-Meier analysis. During the study period, 3451 patients (mean age 73.9, 53.4% male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9%) vs. 6 (1.0%), p = 0.005) and pericardiocentesis (46 (1.6%) vs. 2 (0.3%), p = 0.01) at 1year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7%) vs. 29 (4.6%), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2%)) compared to appendage (46 (1.6%)), free wall (10 (2.1%)), or high atrial septal (2 (4.7%)) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001). Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.

Excitability of hand motor areas during articulation of syllables

It is known that articulating different syllables is linked to different grasp actions, e.g. [ti] is linked to precision grip, and [kɑ] to power grip. The aim of the present study was to test whether articulating or hearing these syllables would result in an increased activity in the representation of hand muscles involved in these two actions in a muscle-specific manner. To this end, we used transcranial magnetic stimulation (TMS) to investigate changes in the excitability of the left primary motor cortex (M1) innervating hand muscles while participants articulated or listened to meaningless syllables, listened to a metronome, or observed a fixation cross. The motor-evoked potentials of two hand muscles associated with either a precision or power grip exhibited significantly greater amplitudes during articulation than in passive listening, metronome, and fixation cross conditions. Moreover, these muscles exhibited similar patterns of excitability during articulation regardless of which syllable was articulated. The increased excitability of the left M1 hand area during articulation, but not during perception of the syllables, might be due to the cortico-cortical interaction between the motor representations of oral organs with the hand area.

Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads

The Medtronic model 4195 (StarFix) left ventricular lead is an active fixation lead that provides additional support within the coronary sinus (CS) via deployable lobes. While this lead has been shown to have excellent stability within the CS, concerns about its extractability have been raised. The aim of this study was to compare the safety and efficacy of the extraction of the model 4195 lead vs other Medtronic CS leads in a prospective cohort study. Patients undergoing extraction of this and other CS leads for standard indications were prospectively enrolled and studied. The primary outcomes of interest were the removal success rates and associated complication rates. Patients were followed for a month postprocedure. The overall left ventricular lead extraction success rate was 97.6% (n = 205). Among 40 patients with chronic model 4195 leads, there were 37 successful extractions (92.5%) as compared to 98.8% for the 165 non-4195 leads. However, in 2 of the 3 StarFix lead extraction failures, standard extraction techniques were not used. All 10 of the model 4195 leads that had been implanted for less than 6 months were extracted without incident. In this largest study of CS lead extractions published to date, the overall success rate of the extraction of chronically implanted CS leads is high and the complication rate is similar in these lead models. The extraction of the model 4195 lead is clearly more challenging, but it can be accomplished in high-volume extraction centers with experienced operators. It is recommended that the model 4195 lead be extracted by experienced operators.

Percutaneous right atrial pacemaker lead repositioning using a regular deflectable ablation catheter.

Lead dislocation is one of the most undesired complications of permanent pacemaker implantation. The rate of dislodgement of atrial pacing leads is nearly 3% [1]. Reopening the pacemaker pocket and repositioning the lead is the most commonly used technique for correcting dislocations which occur in the early period after implantation. However, this increases the risk of pocket infection and increases lead insulation problems. Snare systems and urological baskets have also been used for repositioning atrial leads [2, 3]. We report a patient who experienced dislodgement of the atrial pacemaker lead of a cardiac resynchronization therapy (CRT) device, which was corrected using a regular deflectable ablation catheter by the transfemoral route. A 77-year-old female patient with severe ischemic left ventricular dysfunction and wide QRS had received a CRT device. At the follow-up 1 week after the procedure, atrial sensing and pacing dysfunctions were detected. Fluoroscopy revealed dislodgement of a passive fixation J-shaped atrial lead. Lead repositioning via a percutaneous transfemoral approach was planned to avoid surgical revision. A regular deflectable ablation catheter (steerable 4-mm-tip ablation catheter, Mariner, Medtronic, Minneapolis, USA) was advanced to the right atrium through a 7 Fr introducer from the right femoral vein. We propagated the ablation catheter above the level of the atrial lead and made an anteflexion to the distal portion of the catheter. We captured the distal loop of the atrial lead, then with a slight counterclockwise rotation and pull back we oriented the atrial lead towards the right atrial appendage (Figure 1). The lead functions were normal after the intervention. The patient was discharged the next morning and had normal pacemaker functions at follow-up. Figure 1 Successful atrial lead reposition by deflectable ablation catheter Early lead displacements after pacemaker implantations are the most frequent cause of reintervention in the majority of patients. We performed successful atrial lead repositioning with a deflectable ablation catheter by the percutaneous approach without the need for a surgical operation. However, this technique has a number of contraindications. Percutaneous lead repositioning can only be performed on patients who have passive fixation electrodes and leads with suitable loop anatomy. Conditions which necessitate the removal of the dislocated lead such as serious insulation problems are another contraindication for percutaneous lead repositioning. Repositioning of active fixation leads should be performed surgically. Since our case had a passive fixation atrial lead and a suitable loop anatomy, it was possible to perform the procedure safely. However, operators need to be cautious about dislodgement of other stable leads while performing the procedure, especially in patients with an implanted CRT. Favale et al. reported successful percutaneous atrial lead repositioning in 2 patients with permanent pacemakers and in 1 patient with an implantable cardioverter defibrillator [4]. We believe that our paper is the first one to report percutaneous atrial lead repositioning with a regular deflection ablation catheter in a patient with a CRT device. Although it needs some experience, percutaneous transfemoral lead repositioning is a much less invasive technique and may be preferred as a first-step approach if the patient has acceptable loop anatomy of the atrial lead.