Left Ventricular Pacing Lead Positioning in the Target Vein of the Coronary Sinus: Description of a Challenging Case (original) (raw)
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Heart Rhythm, 2015
BACKGROUND A minority of patients undergoing cardiac resynchronization therapy (CRT) use a surgically placed epicardial left ventricular (SPELV) pacing lead. Previous studies of outcomes in patients receiving such leads have been limited to small cohorts with limited follow-up. OBJECTIVE We sought to compare outcomes between patients receiving SPELV pacing leads and patients with traditional percutaneously placed left ventricular (LV) leads. METHODS We extracted clinical data on consecutive patients undergoing the new implantation of a cardiac resynchronization device. Long-term survival and response (defined as an improvement in LV ejection fraction of Z5%) were compared between the 2 groups.
Journal of Interventional Cardiac Electrophysiology, 2012
A 59-year-old patient with dilated cardiomyopathy, severe systolic left ventricular dysfunction and drug-refractory advanced heart failure (New York Heart Association-NYHA class III-IV symptoms) and prior history of mitral valve replacement was scheduled for implantation of a biventricular pacing system (cardiac resynchronization therapy-defibrillator or CRT-D device). The coronary sinus was cannulated after some effort and a venous coronary angiogram was performed (Panel A). Although a posterolateral cardiac venous branch (Panel A, arrow) was identified to accommodate the left ventricular pacing lead, placement of the lead in this tributary (Panel B) was accompanied by phrenic nerve stimulation, which could not be remedied by moving to more proximal positions where the lead could not be stabilized. Having no other
Europace, 2014
Ideal positioning of left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) is technically demanding. This case aims to place LV lead in anterolateral branch of coronary sinus (CS) using collateral route blindly. Methods and results Externalization via the CS ostium using collaterals retrogrogradely, which was not visible in initial balloon occlusion venography, through one delivery sheath with the support of commonly used micro-guide catheter and subsequent successful LV lead placement in anterolateral branch of CS. Conclusion This innovative retrograde approach for LV pacing lead implantation in anterolateral branch of CS obviated the need for snare technique to capture the distal end of the wire when antegrade route was not successful.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015
To compare the effects on left ventricular (LV) function of right ventricular (RV) septal pacing vs. cardiac resynchronization therapy (CRT) in patients with an indication for the latter. Cardiac resynchronization therapy is an effective therapy in patients with drug-refractory heart failure. Despite advances in implantation techniques, LV lead placement can be impossible in up to 10% of cases. We, therefore, assessed the effects of RV septal pacing from mid septum (RVmIVS) and outflow tract (RVOT) on cardiac performance, in comparison with CRT. Twenty-two patients scheduled for CRT underwent dual-chamber temporary pacing. The ventricular lead was placed at the RV apex (RVA), RVmIVS, and RVOT in random order. Comprehensive echocardiography was performed in a baseline AAI mode and then at each RV position in dual chamber pacemaker function (D pacing, D sensing, D dual responses) mode and repeated on the next day following CRT implantation. Right ventricular apex pacing did not change...