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484 region of the right ventricle and of an atrial lead in the right atrial appendage, the venous access was obtained via the left subclavian vein punc‐ ture and the CS was cannulated with a Selectra Hook‐45 guide catheter (Biotronik, Berlin, Ger‐ many). Simultaneously, the operator had a CS hologram overlapped on a fluoroscopy display (FIGURE 1B), with a possibility of rotation, relocation to any place in space, and zooming with virtual finger moves (FIGURE 1C). As routine coronary venog‐ raphy was recorded, the operator could compare this image with the 3D visualization and predict the target vein to facilitate the access. The com‐ plex evaluation of a favorable venous anatomy was followed by quadripolar LV lead insertion (Sentus OTW‐L QP; Biotronik, Berlin, Germa‐ ny) into the mid‐lateral vein, with optimal pac‐ ing parameters. A CRT device, Intica 7 HF‐T QP (Biotronik, Berlin, Germany), was implanted. During CRT implantation, difficulties may occur, some of which are related to venous ab‐ normalities, limitation of fluoroscopy visual‐ ization, and its reliability. Augmented reality reconstruction has its own limitations, main‐ ly attributed to the accuracy of a computed to‐ mography scan; however, a simultaneous use of both visualization techniques may improve an‐ atomical evaluation of the CS. It can be especial‐ ly useful in venous tortuosity and kinky veins, Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure with low left ventricular (LV) ejection fraction (LVEF) and prolonged QRS duration. However, up to 2% to 5% of implantation proce‐ dures fail, mostly because of anatomical reasons and excessive fluoroscopy use. A 68‐year‐old man with ischemic cardiomyopathy, history of con‐ gestive heart failure, New York Heart Associa‐ tion functional class II, sinus rhythm with a left bundle branch block (QRS, 170 ms), and an LVEF of 30%, was referred for CRT. Computed tomog‐ raphy angiography with reconstruction of coro‐ nary veins was performed before the procedure and confirmed a typical coronary sinus (CS) os‐ tium with a diameter of 7 × 11 mm and at least 2 branches to be considered for LV lead place‐ ment. A 3‐dimensional (3D) model of the ve‐ nous system was created and displayed using augmented reality visualization with the Carna Life system (MedApp, Kraków, Poland). The pro‐ cedure was performed with augmented reality glasses (head‐mounted HoloLens® display; Mi‐ crosoft, Redmond, Washington, United States) (FIGURE 1A) that allowed the operator to use hand gestures to locate CS visualization in a favorable place in space (FIGURE 1A–1C). The CRT implantation procedure was typical. After the placement of a single‐coil DF‐4 defibrillation lead in the apex Correspondence to: Marcin Witkowski, MD, PhD, Department of Cardiology, Medical University of Białystok, ul. M.Skłodowskiej 24a, 15-276 Białystok, Poland, phone: +48 85 831 83 99, email: witkos@onet.pl Received: January 7, 2019. Revision accepted: February 15, 2019. Published online: April 25, 2019. Kardiol Pol. 2019; 77 (4): 484-485 doi:10.33963/KP.14801 Copyright by Polskie Towarzystwo Kardiologiczne, Warszawa 2019 C L I N I C A L V I G N E T T E

kardiologia polska

Cardiac resynchronization device implantation supported by augmented reality visualization of computed tomography angiography reconstruction of the coronary sinus bed: the use of the Carna Life system