Key result
The anti-dromic snare technique enabled successful antegrade re-implantation of a coronary sinus lead into an occluded target vein after transvenous lead extraction.
Why the study?
After coronary sinus lead extraction in CRT patients, occlusion of the extracted branch vessel is a major obstacle to re-implantation, especially when it is the only optimal vessel.
Case Report (n=1)
The anti-dromic snare technique may serve as a safe and effective bail-out strategy for re-implanting a coronary sinus lead into an occluded target vein following lead extraction.
Antidromic snare technique enabled same-vein CS lead re-implantation after extraction-induced occlusion; leaves open its role as a bail-out strategy.
Background: After coronary sinus (CS) lead extraction in patients with cardiac resynchronization therapy (CRT), occlusion of the branch vessel from which CS lead was extracted is a major obstacle to re-implantation, particularly if that vessel is the only optimal vessel for resynchronization. Case summary: A 75-year-old female who underwent CRT implantation 11 years prior presented with worsening dyspnoea, right ventricle-only pacing rhythm, and increased CS lead pacing threshold. Because she was a CRT responder, we decided to replace the malfunctioning CS lead. After successful extraction, the vessel from which CS lead was extracted was not visualized, and guidewire re-insertion attempts failed. No other branch vessels suitable for re-implantation were observed. Fortunately, distal portion of the target vessel was viewed by a retrograde flow of contrast. A guidewire was advanced retrograde into the target vein via a connecting vessel, and the distal end of the guidewire was snared around CS ostium and then pulled out of the sheath. A new CS lead was inserted through the distal end of the guidewire and successfully implanted antegrade into the same target vein using a veno-venous loop of the guidewire ('anti-dromic snare technique'). The patient was discharged 2 days after the procedure without complications. Discussion: Antegrade re-implantation of CS lead may not be possible after extracting CS leads with long dwell times, possibly due to extraction-induced vessel occlusion. If the occluded vessel is the only proper vessel for CS lead re-implantation, the anti-dromic snare technique could be a safe and effective bail-out strategy.
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Kim et al. (2023) conducted a case report in Malfunctioning coronary sinus lead (n=1). Anti-dromic snare technique was evaluated on Successful re-implantation of CS lead. The anti-dromic snare technique enabled successful antegrade re-implantation of a coronary sinus lead into an occluded target vein after transvenous lead extraction.
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