Maneuvering balloon occlusion technique to deflect LV lead into a target branch during CRT implantation |
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Authors: | Ahmed Al Fagih Saleh Al Ghamdi K Dagriri Adil Ahmed Ayman Al Khadra |
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Institution: | (1) Prince Sultan Cardiac Center, P.O. Box 245999, Riyadh, 11312, Saudi Arabia;(2) Prince Sultan Cardiac Center, Riyadh, Saudi Arabia |
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Abstract: | Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy
of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy
(DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of
a 45-year-old woman with DCM requiring lead placement is presented here. To plan for proper LV lead positioning, CS angiography
was obtained through right femoral vein approach with preshaped long sheath (SJM, SL3) and occlusive balloon. For successful
implant of LV lead, with no viable alternatives available, the tortuosity of the lateral and posterolateral branch were overcome
by advancing and inflating the balloon in the main CS to deflect LV lead into the target branch. A unipolar LV lead (Medtronic
4193) was finally placed in a true posterolateral position with excellent sensing and pacing threshold without phrenic nerve
stimulation. |
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Keywords: | |
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