Endocardial LV lead for resynchronization therapy - a viable alternative.

Objectives: Describe an alternative to conventional LV lead placement. Background: Conventional left ventricular (LV) lead placement is not always possible due to anatomic and technical limitations. In selected patients LV endocardial lead placement is a viable alternative. Methods: Five patients on warfarin with unsuccessful coronary sinus lead placements and contraindications to epicardial lead placement elected to undergo addition of an LV endocardial lead. The left ventricle was accessed through the interatrial septum via a combined superior and inferior approach resulting in an active fix lead placed on the LV endocardial surface. Results: All patients underwent successful LV endocardial lead placement. There were no acute procedural complications. Two patients died 2 years following the procedure from unrelated causes. The other patients were alive and well at a mean follow up of 2.8 years, with significant symptomatic improvement and no evidence of cardioembolic complications. Conclusions: The placement of LV endocardial leads is a viable alternative in highly selected patients with limited options.