Key result
Retrograde buddy wire technique overcomes severe tortuosity during left ventricular pacing lead placement.
Why the study?
Anatomic obstacles such as severe tortuosity and angulation at the vein-coronary sinus junction can hamper successful left ventricular lead placement for cardiac resynchronization therapy.
Does the retrograde buddy wire technique enable successful coronary sinus lead placement in patients with severe coronary vein tortuosity?
Case Report (n=1)
Does the retrograde buddy wire technique enable successful coronary sinus lead placement in patients with severe coronary vein tortuosity?
The retrograde buddy wire technique using a second coronary sinus sheath offers a viable procedural solution for overcoming severe venous tortuosity during left ventricular lead placement for cardiac resynchronization therapy.
May complicate coronary sinus lead placement in CRT; extends anatomic descriptions but leaves open systematic evaluation.
Implantation of a left ventricular pacing lead via the coronary sinus to deliver cardiac resynchronization therapy has become standard therapy for patients with New York Heart Association (NYHA) Class III or IV heart failure and significant intraventricular conduction delay. Biventricular pacing has been shown to provide both symptomatic and mortality benefit in appropriately selected patients. There is significant variability in the anatomy of the coronary sinus and the epicardial coronary venous system. Although a suitable candidate vein may be identified during coronary venography, efforts toward successful guidewire placement or lead placement may be hampered by anatomic obstacles. In this case report, we provide a solution to overcome severe tortuosity encountered at the vein-coronary sinus junction and angulation of the proximal vein. The use of a second coronary sinus sheath and a retrogradely placed guidewire may overcome this anatomic obstacle of vessel tortuosity, when placement by other means has proven unsuccessful.
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DOBESH et al. (2011) conducted a case report in Heart failure requiring cardiac resynchronization therapy (n=1). Retrograde buddy wire technique (second coronary sinus sheath and retrogradely placed guidewire) was evaluated on Successful guidewire or lead placement overcoming severe tortuosity. A retrograde buddy wire technique using a second coronary sinus sheath and retrogradely placed guidewire can overcome severe tortuosity during left ventricular pacing lead placement.
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