Targeted left ventricular endocardial pacing was successfully achieved in 8 of 9 patients with failed coronary sinus lead placement, with no acute complications or embolic events during follow-up.
Observational (n=9)
Is targeted left ventricular endocardial pacing feasible and safe in patients with failed coronary sinus lead placement?
Targeted left ventricular endocardial pacing is a feasible and potentially safe alternative for cardiac resynchronization therapy when standard coronary sinus lead placement fails.
AIMS: Cardiac resynchronization therapy via the coronary sinus (CS) is not always possible. Left ventricular (LV) endocardial lead placement is a potential alternative. The purpose of this study was to assess the feasibility of endocardial LV pacing using a steerable lead introducer and active fixation polyurethane lead. METHODS AND RESULTS: Endocardial LV lead placement was attempted in nine patients (seven males, age 48-77 years) in whom transvenous CS lead placement had failed. Trans-septal puncture and septal dilatation were performed via the femoral route. A steerable introducer catheter was advanced across the septal puncture site from the right or left subclavian vein into the LV. An active fixation polyurethane lead was then implanted into the high postero-lateral aspect of the LV endocardial wall. All patients were anticoagulated following implant. Successful LV lead placement was achieved in eight patients. There were no acute complications and no embolic events during follow-up (1-32 months). All implanted patients responded well with either improvement in New York Heart Association class or maintenance of symptomatic improvement that had previously been conferred by LV epicardial pacing. CONCLUSION: Targeted LV endocardial pacing is a potential alternative to CS pacing and warrants a trial to characterize long-term benefits and risks.
Morgan et al. (Fri,) conducted a observational in Failed transvenous coronary sinus lead placement for cardiac resynchronization therapy (n=9). Endocardial left ventricular lead placement using a steerable introducer and active fixation lead was evaluated on Successful left ventricular lead placement. Targeted left ventricular endocardial pacing was successfully achieved in 8 of 9 patients with failed coronary sinus lead placement, with no acute complications or embolic events during follow-up.
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