Transseptal approach to the implantation of cardiac resynchronization therapy

Introduction. In patients with cardiac resynchronization therapy left ventricular lead is usually placed through a tributary vein of the coronary sinus. However, when this approach failed, the atrial transseptal approach is mostly used for endovascular left ventricular lead placement, but it is quite difficult to perform. Case report. 59-years-old patient, male, was hospitalized due to endovascular left ventricular lead placement by atrial transseptal approach, after failed attempt via coronary sinus vein. Non-ischemic dilated cardiomiopathy was verified 1 year ago. Endoventricular lead was introduced by left subclavian approach and advanced through the previously punctured hole in the left atrium cavity and over mitral valve placed in posterolateral part of left ventricular. Both right ventricular defibrillator lead and atrial electrode were implanted routinely in the right ventricle septum and right atrial appendage. Conclusion. Left ventricular endocardial lead implantation by atrial transseptal approach is a feasible and safe in patients with previously failed implantation via tributary vein of the coronary sinus.