Key result
Left ventricular lead placement via a collateral pathway was successfully performed without complications in a patient with complete coronary vein ostium obstruction, improving subjective symptoms.
Case Report (n=1)
Left ventricular lead placement for CRT via a collateral pathway is technically feasible and can improve symptoms in patients with complete obstruction of the coronary vein ostium.
May enable CRT via collaterals in obstructed coronary veins; hypothesis-generating and should not yet change practice.
A 71-year-old man with dilated cardiomyopathy and complete atrioventricular block underwent cardiac resynchronization therapy (CRT) due to chronic heart failure that was not improved by conventional medical treatment. But we found the coronary vein ostium was completely obstructed by coronary venography. The contrast medium flowed out from the right atrium via a collateral pathway. Thus a left ventricular lead was placed via a collateral pathway and was successfully implanted without complications. The postoperative threshold was 2.7 V at 0.4 ms. The subjective symptom improved after CRT. The safety of this procedure was not clear.
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Soga et al. (2007) conducted a case report in Dilated cardiomyopathy and complete atrioventricular block with chronic heart failure (n=1). Left ventricular lead placement via a collateral pathway was evaluated on Successful implantation and symptom improvement. Left ventricular lead placement via a collateral pathway was successfully performed without complications in a patient with complete coronary vein ostium obstruction, improving subjective symptoms.
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