Key result
Iliac vein CRT implantation shows feasibility and improves cardiac function despite occluded superior access.
Why the study?
CRT benefits patients with heart failure and LBBB, but implantation is challenging when superior venous access is not feasible.
Is iliac vein access feasible for CRT implantation in a patient with occluded superior venous access?
Case Report (n=1)
No
Is iliac vein access feasible for CRT implantation in a patient with occluded superior venous access?
Iliac vein access is a feasible and stable alternative for CRT implantation in patients without superior venous access, potentially avoiding the risks of thoracotomy.
May support iliac vein CRT access in select superior occlusion cases; leaves open need for prospective validation before broader adoption.
Background: Cardiac resynchronization therapy (CRT) has been shown to benefit patients with heart failure and left bundle branch block (LBBB). However, CRT implantation is challenging when the superior venous access is not feasible. Case summary: A 50-year-old man with a history of dilated cardiomyopathy and complete LBBB was referred to our hospital for CRT management. Angiography showed that the left and right brachiocephalic veins were occluded. Cardiac resynchronization therapy was finally implanted via the iliac vein. Follow-up echocardiography showed improved cardiac function, and the pacing system was functioning properly. Discussion: The iliac vein access is feasible for CRT implantation with good stability, which can be a viable alternative to avoid unnecessary risk associated with thoracotomy and epicardial lead placement.
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Xu et al. (2023) conducted a case report in Dilated cardiomyopathy with complete LBBB and occluded superior venous access (n=1). Cardiac resynchronization therapy (CRT) via iliac vein approach was evaluated on Cardiac function and pacing system function. In a 50-year-old man with occluded superior venous access, cardiac resynchronization therapy implantation via the iliac vein was feasible and improved cardiac function.
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