Key result
LV lead revision resolves diaphragmatic stimulation caused by lead traversal into the pericardial space.
Why the study?
Diaphragmatic stimulation following cardiac resynchronization therapy due to unusual LV lead positioning required investigation and management.
Case Report (n=1)
Alerts to rare pericardial LV lead traversal in diaphragmatic stimulation; leaves open its incidence and prevention strategies.
During a left ventricular (LV) lead revision for diaphragmatic stimulation in a BiV-ICD patient, the fluoroscopic image of coronary sinus (CS) venogram showed that the LV lead was not along the CS, but along the ventricular septum and possibly traversed the right ventricular (RV) apex to pericardial space ( Figure 1 A ). Neither a middle cardiac vein nor other venous tributaries could be identified, and the LV lead course via the RV apex to the pericardial location close to the diaphragm was confirmed by CT image. A new LV lead was positioned in the cannulated CS and tested for adequate threshold without any diaphragmatic stimulation. Figure 1 B shows the initial post-implantation chest X-ray ruling out lead migration. ( A ) LAO view showing the Coronary Sinus cannulation, ( B ) Posteroanterior chest X-ray after original implantation.
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Afonso et al. (2008) conducted a case report in Diaphragmatic stimulation following cardiac resynchronization therapy (n=1). Left ventricular lead revision was evaluated. Left ventricular lead revision successfully resolved diaphragmatic stimulation caused by an unusual lead course traversing the right ventricular apex to the pericardial space.
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