Stylets, Attain Command Catheters, LV Leads

Question 1

Which stylet is used to position the RV lead on the septum?

Answer 1

• a multipurpose curved shape or Amplatz curved stylet for mid to high septal placement
• a lesser J-curve for lower septal placement

Question 2

Which stylet is best for placing the RA lead into the Right Atrial Appendage (RAA)?

Answer 2

J-shaped for placement into the RAA or high RA septum

Question 3

What are the outer (OD) and inner (ID) dimensions for the Attain Command family of catheters?

Answer 3

• 9.0 Fr OD
• 8.5 Fr (tapered distal end if applicable)
• 7.2 Fr ID

Question 4

What does the “X” mean for the following Attain Command catheters:
- Multipurpose X and MB2 X

Answer 4

• an “X” identifies the catheter as having a tapered distal end
• goes from 9.0 (proximal) to 8.5 Fr (distal tip)

Question 5

What are the lengths in cm for the Straight Attain Command family of catheters?

Answer 5

• 45 cm
• 50 cm (most)
• 57.5 cm

Question 6

What is the length in cm for the Multipurpose X Attain Command catheters?

Answer 6

• 50 cm; also has a tapered distal end

Question 7

What is the length in cm for the Multipurpose Attain Command catheter?

Answer 7

45 cm

Question 8

What is the length in cm of the Extended Hook Extra Large Attain Command catheter?

Answer 8

57.5 cm

Question 9

What is the length in cm of the Extended Hook Attain Command catheter?

Answer 9

50 cm

Question 10

What is the length in cm of the Amplatz Attain Command catheter?

Answer 10

• 50 cm
• catheter has a double curve

Question 11

What is the length in cm of the Multipurpose Right Attain Command catheter?

Answer 11

45 cm; needed if access is on the patient’s right

Question 12

What is the length in cm of the 3D Attain Command catheter?

Answer 12

45 cm

Question 13

What shape is a 6250-45S, 50S or 57.5S and can it be deep seated in the CS?

Answer 13

• straight shaped and yes, it can be deep seated in the CS
• need a steerable EP or Attain Select catheter to cannulate the CS

Question 14

Can a 6250-MP or 6250-MPX be deep seated in the CS?

Answer 14

only the 6250-MPX can be deep seated into the CS or used to sub-select a CS branch due to its tapered end

Question 15

Which of the 6250 Attain Command catheters can be deep seated into the CS?

Answer 15

• straight
• Multipurpose (MPX)
• MB2X
• extended hook

Question 16

Which of the 6250 Attain Command catheters can be used as a sub-selector for CS cannulation?

Answer 16

• straigtht
• Multipurpose (MPX)
• MB2X

Question 17

Which Attain Command catheter should be used to gain CS access in patients with atrial enlargement or has a CS with a vertical take-off?

Answer 17

6250-EH or 6250-EHXL
- extended hook

Question 18

In which patients is the Extended Hook (6250-EH or 6250-EHXL) Attain Command catheter a good choice for CS cannulation/access?

Answer 18

patients with atrial enlargement or who have a CS with a vertical take-off?

Question 19

Which Attain Command catheter should be used to gain CS access in patients where the CS is obstructed by the Thebesian Valve?

Answer 19

6250-AM
- amplatz catheter
- lead with a guidewire so the tip does not prolapse

Question 20

Which Attain Command catheter should be used to gain CS access in patients where a right sided approach is being used?

Answer 20

6250-MPR
- Multi-purpose Right

Question 21

In which patients is the 6250-AM (amplatz) Attain Command catheter a good choice for CS cannulation/access?

Answer 21

patients where the CS is obstructed by the Thebesian Valve

Question 22

In which patients is the 3D curve Attain Command Surevalve catheter a good choice for CS cannulation/access?

Answer 22

use when the CS is more posterior than normal

Question 23

The Attain Perform 4598 is recommended for what size vessels?

Answer 23

Medium to Large diameter vessels

Question 24

The Attain Perform 4298 is recommended for what size vessels?

Answer 24

Medium vessel diameter

Question 25

The Attain Perform 4398 is recommended for what size vessels?

Answer 25

Small diameter vessels or with acute curvatures

Question 26

What is the model number for there Attain Stability Quad LV lead?

Answer 26

4798

Question 27

What type of lead is the 4798?

Answer 27

Active fix LV lead -> has helix in between poles 2-3 with a mechanical stop to prevent over fixating and possible vessel trauma

Question 28

How is the Attain Stability Quad (4798) fixated to the vessel wall?

Answer 28

A helix in between poles 2-3 -> 0.2mm in diameter -> is electrically inactive -> has mechanical stop to prevent over rotation

Question 29

What are the distances for the following on an Attain Performa family of the quadripolar leads: 1) LV1 to LV2 2) LV2 to LV3 3) LV3 to LV4

Answer 29

1) 21mm 2) 1.2mm 3) 21mm

Question 30

What is important to remember when inserting/advancing the Attain Stability Quad (4798) lead through the Surevalve of the attain command catheter?

Answer 30

Rotate the lead counterclockwise as it is advanced thru the Surevalve

Question 31

When should lead testing be done when implanting a 3830 Attain Stability Quad lead?

Answer 31

After the lead is fixated because the position of the electrodes will change/move as the lead is screwed in place

Question 32

What is done to ensure the helix of the 3830 Attain Stability Quad lead is properly fixed?

Answer 32

- retract the guide wire to appx LV4 and perform the Push and Pull test under live fluoroscopy

Question 33

Should the 3830 Attain Stability Quad lead be wedge into place?

Answer 33

No, wedging the lead may prevent helix rotation and fixation

Question 34

What items are included with the 3830 Attain Stability Quad packaging?

Answer 34

- 4 straight stylets (2 grey, 2 purple) - 2 j-shaped stylets - guidewire insertion tool - 1 torque tool - 1 guidewire clip

Question 35

What is the purpose of the j-shaped stylets that come with the 3830 Attain Stability Quad lead?

Answer 35

Stylets are used to pressed the helix against the vessel wall when screwing into place