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Variations of coronary sinus anatomy can make a superior approach difficult or even impossible for left ventricular (LV) lead delivery. We describe a new technique in which the LV lead was placed in a cardiac vein via the right femoral vein and then pulled up through the venous circulation to the subclavian vein and a conventionally sited generator.

Femoral vein implantation with subclavian vein pullthrough for left ventricular lead placement