Left ventricular lead implantation using the crossover technique in a steeply bifurcated lateral branch

Figures

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  Figure 1. A: A 12-lead electrocardiogram before device implantation. B: Echocardiography 4-chamber view before device implantation. The left atrium shows significant enlargement.

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  Figure 2. A: Coronary venography showing the steep branching of a lateral vein from the giant coronary sinus (CS). B: Successful engagement of the steeply branched lateral vein using the TEMPO SIM1 catheter (Cordis, Miami, FL). Lateral vein contrast with the TEMPO SIM1 catheter. C: A microcatheter and 0.014-inch stainless steel core guidewire for endovascular therapy enabled passage through the tortuous lateral vein. The wire (arrowheads) was placed in the superior vena cava (SVC). D: Placing the 0.014-inch wire tip in the SVC allowed for the easy advancement of the left ventricular (LV) lead–guiding catheter. E: The LV lead was successfully implanted at the mid portion of the lateral vein.

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  Figure 3. A: Twelve-lead electrocardiogram after device implantation. B: Chest radiography showing 60.5% cardiothoracic ratio after device implantation.