Novel lead anchor technique using an active fixation quadripolar left ventricular lead in cardiac resynchronization therapy

Figures

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  FIGURE 1. Contrast venography demonstrating a tortuous posterolateral coronary sinus vessel

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  FIGURE 2. (A) The Medtronic Attain Stability Quad lead. The 5.6‐French non‐electrically active side helix is positioned between the third and fourth electrodes. This picture is provided by Medtronic Japan. (B) Once the LV lead is positioned as deep as possible, it is rotated clockwise and active temporary fixation is performed (arrow ①). (C) Pulling the active fixation lead (arrow ②) while advancing the cannulation catheter deeper (arrow ③). Deep engagement of the cannulation catheter is obtained without the LV lead falling out. (D) After deep engagement, the lead is rotated counterclockwise, fixation mechanism is released from the vein wall, LV lead is advanced to the desired position (arrow ④), and refixation is performed. Deep engagement of the cannulation catheter provides backup support and helps the LV lead to cross the lesion. LV, left ventricular

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  FIGURE 3. (A) During the “lead anchor technique” is performed. Deep engagement of the cannulation catheter is obtained. (B) After the “lead anchor technique” is performed. The last helix position within the coronary sinus. The pacing threshold was 1.25V/0.4 ms at LV1 to LV2. LV, left ventricular

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  FIGURE 4. (A) pre‐cardiac resynchronization therapy (CRT) implantation electrocardiogram (ECG). QRS length = 208 ms, PR length = 316 ms. (B) post‐CRT implantation ECG. QRS length = 170 ms