Coronary stent fixation of left ventricular lead during CRT-D implantation: a case series of three patients

Objective To investigate a salvage method using coronary stent fixation of the left ventricular (LV) lead to manage refractory LV lead dislodgement caused by unfavorable coronary venous anatomy during cardiac resynchronization therapy defibrillator (CRT-D) implantation, and to evaluate its technical feasibility and clinical value. Methods We retrospectively included three patients with heart failure with reduced ejection fraction (HFrEF) at our center who developed LV lead dislodgement during or early after CRT-D implantation. Conventional methods failed to maintain a stable lead position. A sirolimus-eluting coronary stent was deployed within the target coronary vein to achieve mechanical anchoring of the LV lead via gentle compression against the venous wall. Procedural details, perioperative complications, and follow-up data were collected and analyzed. Results All three patients completed stent fixation of the LV lead. No acute severe complications, such as coronary venous rupture, pericardial tamponade, or lead conductor damage, occurred intraoperatively. No significant change in pacing threshold was observed before and after stent deployment. Cases 1 and 2 were followed for 30 and 26 months, respectively, and lead parameters remained stable. Case 3 was followed for only 2 months and then lost to follow-up; lead parameters were stable at that time point. No clinically meaningful improvement in LV ejection fraction (LVEF) was observed in Cases 1 and 2 during follow-up. Because Case 3 was followed for only 2 months, shorter than the usual 6–12-month window for assessing CRT reverse remodeling, functional response could not be evaluated. This procedure constitutes off-label device use; after full stent deployment, the lead position cannot be readjusted. If device-related infection occurs, transvenous lead extraction may be difficult and uncertain, and surgical removal may be required. Conclusions After all conventional methods have failed, stent fixation may serve as a salvage option for refractory LV lead dislodgement caused by unfavorable coronary venous anatomy. This report describes the clinical observations of sirolimus-eluting stent use in this off-label salvage procedure and details the relevant procedural parameters and techniques. However, the sample size is small, and potential long-term risks, including stent fracture, lead insulation damage, and stability of lead electrical parameters, require further evaluation in larger studies. This technique only addresses the mechanical fixation of the lead and does not guarantee functional benefit from CRT.