IMPLANTATION
21
4. Remove the fixation tool from the terminal pin by pressing the handles of
the tool together.
If the helix mechanism fails to function properly during repositioning, the
following caution must be carefully observed to avoid possible tissue
snagging when removing the lead:
CAUTION:
Do not use the lead if the helix cannot be retracted during
implant. Continuous
counterclockwise
rotation of the lead body during
lead removal is necessary to avoid inadvertent tissue trauma.
Counterclockwise lead rotation helps to prevent accidental fixation and
releases the electrode helix if tissue snagging has occurred.
Checking for Lead Stability
After fixation, partially withdraw the stylet 8 to 10 cm. Check the stability of
the lead using fluoroscopy. If possible, have the patient cough or take
several deep breaths. When electrode position is satisfactory, completely
withdraw the stylet.
CAUTION:
Should dislodgment occur, immediate medical care is required
to resolve the electrode position and minimize endocardial trauma.
Repositioning the Lead
If the lead needs repositioning, verify the stylet is fully inserted in the lead,
reconnect the fixation tool, and rotate the tool
counterclockwise
to retract
the helix. Use fluoroscopy to verify that the helix is retracted and
disengaged completely from the heart wall before attempting to reposition
the lead. Reaffix the electrode (helix) using the procedures previously
discussed in the Positioning the Lead, Lead Fixation, and Checking for
Lead Stability sections. Do not rotate the fixation tool more than the
maximum number of turns indicated in the Specifications (Page 30).
Continuing to rotate the terminal pin once the helix is fully extended or
retracted (as indicated by fluoroscopy) can damage the lead.
Evaluating Lead Position
Verify electrical performance of the lead
before
attaching the lead to the
pulse generator and
after
allowing sufficient time for the effect of local
tissue trauma to subside. The use of radiography or fluoroscopy during the
operation may help ensure lead position and integrity. If testing results are
unsatisfactory, lead system repositioning or replacement may be required.
Minimizing Pacemaker Interaction
To minimize potential interaction between a permanent pacemaker and an
ICD pulse generator, consider the following:
5, 6
5.
Epstein AE, et al. Combined automatic implantable cardioverter-defibrillator and pacemaker
systems: implantation techniques and follow-up. JACC. 1989;13:121-131.
6.
Calkins H, et al. Clinical interactions between pacemakers and automatic implantable
cardioverter-defibrillators. JACC. 1990;16:666-673.
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