Key result
An indigenous venovenous snare made from a coronary guidewire was successfully used to facilitate left ventricular lead placement during cardiac resynchronization therapy in a patient with difficult anatomy.
Why the study?
In cardiac resynchronization therapy, left ventricular lead placement at the desired position may be difficult due to abnormal coronary sinus and lateral vein anatomy.
Case Report (n=1)
An indigenous snare made from standard coronary angioplasty hardware can be successfully used to facilitate difficult left ventricular lead placement during cardiac resynchronization therapy.
Answers are grounded in this paper and cite their sources.
May enable cost-effective LV lead placement in resource-limited CRT-D cases; hypothesis-generating and should not yet change practice.
BACKGROUND: In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used 'an indigenous snare' made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory. CASE SUMMARY: A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully. DISCUSSION: We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.
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Reddy et al. (2020) conducted a case report in Chronic heart failure requiring cardiac resynchronization therapy (n=1). Venovenous snare made from coronary guidewire was evaluated on Successful implantation of the left ventricular lead. An indigenous venovenous snare made from a coronary guidewire was successfully used to facilitate left ventricular lead placement during cardiac resynchronization therapy in a patient with difficult anatomy.
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