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Case Reports
. 2022 Sep 15;13(9):5159-5163.
doi: 10.19102/icrm.2022.130902. eCollection 2022 Sep.

His-bundle Pacing as a Bailout Therapy for a Patient with Subclavian Stenosis and No Suitable Coronary Sinus Branch: A Double Whammy

Wasim Rashid  1 , Ibrahim Shah  2 , Michael Soos  2 , Khalil Kanjwal  2
Affiliations
Case Reports

His-bundle Pacing as a Bailout Therapy for a Patient with Subclavian Stenosis and No Suitable Coronary Sinus Branch: A Double Whammy

Wasim Rashid et al. J Innov Card Rhythm Manag. .

Abstract

We present an interesting case of an 88-year-old man who was referred to our arrhythmia service for an upgrade of his dual-chamber pacemaker to a biventricular pacemaker for right ventricular pacing-induced cardiomyopathy. The patient was found to have stenosis of the left subclavian vein. Here, we describe the approach used to perform venoplasty in this patient. After venoplasty of the left subclavian vein, the patient did not have suitable coronary venous anatomy for deployment of the coronary sinus lead. Subsequently, a His lead was implanted. We achieved significant narrowing of the QRS with good thresholds and other lead parameters. Through this case report, we seek to present our approach of venoplasty in patients with occluded venous access for either an upgrade or a de novo implant.

Keywords: Cardiac resynchronization therapy; His pacing; subclavian stenosis.

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Conflict of interest statement

The authors report no conflicts of interest for the published content. No funding information was provided.

Figures

Figure 1:
Figure 1:
A venogram of the left subclavian venous system revealed subclavian vein stenosis and collaterals.
Figure 2:
Figure 2:
A 0.035-in angled Navicross catheter was advanced over an angled glidewire advantage and was successful in crossing the total occlusion.
Figure 3:
Figure 3:
Coronary sinus venography was performed, which revealed a tortuous lateral branch that tapered abruptly.
Figure 4:
Figure 4:
The final position of the His lead.
Figure 5:
Figure 5:
Pre- (A) and postprocedure (B) electrocardiograms showed a significant narrowing after His lead implantation.
See this image and copyright information in PMC

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