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Heart Rhythm. 2007 Apr;4(4):454-60. Epub 2006 Nov 29.

Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy.

Author information

1
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. carlgr@cze.nl <carlgr@cze.nl>

Abstract

BACKGROUND:

Coronary sinus (CS) lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a failure rate at implant and short-term follow-up between 10% and 15%.

OBJECTIVE:

The purpose of this study was to assess the feasibility of transseptal endocardial LV pacing in patients in whom transvenous CS lead placement had failed.

METHODS:

An atrial transseptal LV lead placement was attempted in 10 patients (six females, age 69.4 +/- 9.6 years), in whom CS lead placement for CRT had failed. After transseptal puncture and septal dilatation from the femoral route, the left atrium was cannulated with a combination of catheters and guide wires from the left or right subclavian vein. After advancement of this guide catheter into the LV, a standard bipolar screw-in lead could be implanted in the posterolateral wall. All patients were maintained on anticoagulant therapy with warfarin after implant.

RESULTS:

An LV lead could be successfully implanted in nine of the 10 patients. The stimulation threshold was 0.78 +/- 0.24 V, and the R-wave amplitude was 14.2 +/- 9.7 mV. At 2 months' follow-up, the stimulation threshold was 1.48 +/- 0.35 V with a 0.064 +/- 0.027 ms pulse width. There was no phrenic nerve stimulation observed in any of the patients. There were no thromboembolic complications at follow-up.

CONCLUSIONS:

LV transseptal endocardial lead implantation from the pectoral area is a feasible approach in patients with a failed CS approach and in whom epicardial surgical lead placement is not an option. Longer follow-up is warranted to determine the risk of thromboembolic complications.

PMID:
17399634
DOI:
10.1016/j.hrthm.2006.11.023
[Indexed for MEDLINE]
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