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Case Reports
. 2016 Sep;68 Suppl 2(Suppl 2):S212-S215.
doi: 10.1016/j.ihj.2016.02.023. Epub 2016 Mar 15.

Veno-venous loop through coronary sinus for LV lead placement during cardiac resynchronization therapy

Ranjit Kumar Nath  1 , Ajay Raj  2 , C Parvatagouda  3 , Neeraj Pandit  4
Affiliations
Case Reports

Veno-venous loop through coronary sinus for LV lead placement during cardiac resynchronization therapy

Ranjit Kumar Nath et al. Indian Heart J. 2016 Sep.

Abstract

Left ventricular lead placement in the appropriate branch of coronary sinus is the key to successful cardiac resynchronization therapy (CRT) and this step is technically challenging. We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized. Over this loop, the left ventricular lead of the CRT-D device was implanted successfully. This novel approach can be used to successfully implant the LV lead in difficult to implant situations, obviating the need for thoracotomy or other methods of LV lead implantation.

Keywords: Coronary sinus; LV lead; Snare; Veno-venous loop.

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Figures

Fig. 1
Fig. 1
Levo phase of coronary angiogram in PA view showing CS and lateral branch (arrow) (A) and attempted delivery of quadripolar LV lead into the lateral branch with the help of a subselector (B).
Fig. 2
Fig. 2
The 0.014″ guidewire advanced into SVC through RA (A) and the wire snared from SVC with the help of a goose neck snare from left subclavian vein through another access alongside the CS sheath (B).
Fig. 3
Fig. 3
Formation of a veno-venous loop with both ends of the guidewires in the operator's hand (A) and advancing the LV quadripolar lead easily over the wire into the CS branch (B).
Fig. 4
Fig. 4
Snapped guidewire trapped by the snare in the middle cardiac vein (A) and final position of the leads of the CRT-D device (B).
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References

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