Abstract
Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy (DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of a 45-year-old woman with DCM requiring lead placement is presented here. To plan for proper LV lead positioning, CS angiography was obtained through right femoral vein approach with preshaped long sheath (SJM, SL3) and occlusive balloon. For successful implant of LV lead, with no viable alternatives available, the tortuosity of the lateral and posterolateral branch were overcome by advancing and inflating the balloon in the main CS to deflect LV lead into the target branch. A unipolar LV lead (Medtronic 4193) was finally placed in a true posterolateral position with excellent sensing and pacing threshold without phrenic nerve stimulation.
This is a preview of subscription content, log in via an institution to check access.
Abbreviations
- CRT:
-
Cardiac resynchronization therapy
- CS:
-
Coronary sinus
- DCM:
-
Dilated cardiomyopathy
- LV:
-
Left ventricular
- LVEF:
-
Left ventricular ejection fraction
- NYHA:
-
New York Heart Association
- RV:
-
Right ventricular
References
Epstein, A. E., DiMarco, J. P., Ellenbogen, K. A., Mark Estes, N. A., Freedman, R. A., Gettes, L. S., et al. (2008). ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 51, 1–62.
Al-khadra, A. S. (2005). Use of preshaped sheath to plan and facilitate cannulation of the coronary sinus for the implantation of cardiac resynchronization therapy device. Pacing and Clinical Electrophysiology, 28(6), 489–492.
Curnis, A., Neri, R., Mascioli, G., Tiano, L., Belardinelli, R., Carnevelli, P., et al. (2000). Left ventricular pacing lead choice based on coronary sinus venous anatomy. European Heart Journal Supplements, 2, J31–J35. Suppl J.
Kautzner, J., Riedbauchova, L., Cihak, R., & Vancura, V. (2004). Technical aspects of implantation of LV lead for cardiac resynchronization therapy in chronic heart failure. Pacing and Clinical Electrophysiology, 27(6Pt1), 783–790.
Delurgio, D., Gottipaty, V., Turk, K. T., Holman, W. L., Sanders, P., Hacini, M., et al. (2004). Long term improvement in coronary venous lead implant procedure. Heart Rhythm, 1, S-152.
Liem, L. B., Eversull, C., & Chun, S. H. (2003). Accessibility of desirable coronary sinus tributary sites in patients undergoing cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 26(II), S89.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Al Fagih, A., Al Ghamdi, S., Dagriri, K. et al. Maneuvering balloon occlusion technique to deflect LV lead into a target branch during CRT implantation. J Interv Card Electrophysiol 29, 33–36 (2010). https://doi.org/10.1007/s10840-009-9417-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-009-9417-4