Safety and efficacy of orthodromic snare technique in left ventricular lead delivery in cardiac resynchronization implantation

Background Cardiac resynchronization therapy (CRT) improves ventricular function, but a positive response to CRT is often limited due to left ventricular (LV) lead placement in a suboptimal position. Complex coronary venous anatomy can hinder the placement of an LV lead in the target vessel, leading to poor CRT response. Objective To report experience with snare‐assisted LV lead delivery in CRT and compare outcomes with the conventional LV lead delivery. Methods This is a single‐center retrospective case–control study of CRT implants between 2016 and 2021. Snare‐assisted lead delivery was performed in cases where conventional lead placement failed or when a preferred target vessel had anatomy amenable to the technique. Safety and outcomes were compared to conventional LV lead placement cases. Results Among 180 CRT cases, 33 were snare‐assisted, and 147 were conventional LV lead placements. Median follow‐up was 924 days in the snare and 618.5 days in the control group. The lead placement was successful in 28/33 snare and 138/147 control cases. A mid‐vessel segment was attained in 89.3% of snare and 72.5% of control cases( p = .03). The apical position was more frequently observed in the control group (26.8% vs. 7.1%, p = .03). All‐cause mortality trended lower in the snare group (6.1%) compared to (17.1%) in the control group ( p = .13). Conclusion Snare‐assisted LV lead delivery is a safe and effective technique that can be utilized for overcoming complex venous anatomy.