PMC5420021_01
Specific characteristics of the Protego DF-1 Pro MRI S DX lead.
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We report our implant technique using Protego DF-1 Pro MRI S DX (Biotronik SE&Co KG, Berlin, Germany) right ventricle (RV) lead, a pentapolar MR conditional implantable cardioverter-defibrillator lead with active fixation, and a floating atrial dipole to detect atrial signals (Figure 1).
A: Venogram taken from the persistent left superior vena cava showing a posterior coronary vein suitable for left ventricle (LV) lead placement. Note the high-lateral right atrial placement of the atrial sensing dipole. B: Selective venogram from the posterior vein. C: Right anterior oblique view of the active fixation lead placed in the posterior coronary vein chosen as target. D: Left anterior oblique view of the active fixation LV lead placed inside the target coronary vein.
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The CS was accessed via the same cephalic vein; a venogram taken from the CS revealed a challenging posterior coronary vein (Figure 2A and B). Eventually, an active fixation LV lead was placed (Attain Stability 20066, Medtronic Inc, Figure 2C and D), given the high risk of LV lead dislodgement owing to the coronary vein anatomy and to the repeated subselector dislodgements during the procedure.
Long-term electrical performance of both leads at 4 months follow-up.
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CRT was delivered 97% of the time owing to some premature ventricular contractions (Figure 3). Clinical improvement and reverse remodeling have occurred: NYHA I, LV ejection fraction = 44%, end-systolic volume = 95 mL, end-diastolic volume = 170 mL. Owing to the dedicated algorithm for atrial sensing, the system effectively detected atrial signal (P-wave amplitude ranged from 2 to 7 mV, Figure 3) and correctly delivered CRT for 97% of beats (Figure 3).