A right sided multipolar catheter and bipolar lead effectively improved QRS duration and heart failure symptoms in a patient with dextrocardia after CRT-P placement.
Does CRT-P placement using a right-sided multipolar catheter and bipolar lead improve QRS, EF, and symptoms in a patient with dextrocardia and HFrEF?
A right-sided coronary sinus cannulation system and bipolar lead are useful and effective strategies for CRT-P implantation in patients with dextrocardia.
Absolute Event Rate: 0% vs 0%
Abstract Background Cardiac resynchronization therapy pacemaker (CRT-P) placement and coronary sinus cannulation (CSC) are notably challenging in dextrocardia (DXC). Case summary A 56 year old female with DXC, sick sinus syndrome (SSS), paroxysmal atrial fibrillation (pAF), and heart failure reduced ejection fraction (HFrEF) presented for symptoms with exertion. Electrocardiogram (ECG) showed prolonged QRS necessitating CRT-P and CSC with right sided multipolar catheter and bipolar lead. Post operatively there was improvement in QRS, EF, and symptoms. Discussion CRT-P and CSC techniques in levocardia are well established. DXC requires unconventional CRT-P strategies. A right sided multipolar catheter is valuable for CSC in DXC. This DXC case utilized a right sided electrophysiology catheter and bipolar coronary sinus (CS) lead. The use of these devices ensured that if the prior right ventricular (RV) ICD lead failed, a standard high S1 lead would be compatible with pacemaker headers. Take Home Message A right sided CSC system is useful for implanting CS leads with a left-sided device in DXC. While it comes at the expense of losing different pacing vectors, a bipolar CS lead is essential if there is a risk that the pre-existing bipolar RV lead will fail.
Khasnavis et al. (Sat,) reported a other. A right sided multipolar catheter and bipolar lead effectively improved QRS duration and heart failure symptoms in a patient with dextrocardia after CRT-P placement.