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Retrograde Buddy Wire Technique for Coronary Sinus Lead Placement—An Approach to Overcome Coronary Vein Angulation
Author(s) -
DOBESH DAVID P.,
COSTEAS CONSTANTINOS A.,
PAMIDI MANDHAVI,
ROELKE MARC,
RUBENSTEIN DONALD G.
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03053.x
Subject(s) - medicine , coronary sinus , coronary vein , cardiac resynchronization therapy , cardiology , great cardiac vein , lead (geology) , sinus (botany) , venography , heart failure , radiology , ejection fraction , botany , geomorphology , thrombosis , geology , biology , genus
Implantation of a left ventricular pacing lead via the coronary sinus to deliver cardiac resynchronization therapy has become standard therapy for patients with New York Heart Association (NYHA) Class III or IV heart failure and significant intraventricular conduction delay. Biventricular pacing has been shown to provide both symptomatic and mortality benefit in appropriately selected patients. There is significant variability in the anatomy of the coronary sinus and the epicardial coronary venous system. Although a suitable candidate vein may be identified during coronary venography, efforts toward successful guidewire placement or lead placement may be hampered by anatomic obstacles. In this case report, we provide a solution to overcome severe tortuosity encountered at the vein—coronary sinus junction and angulation of the proximal vein. The use of a second coronary sinus sheath and a retrogradely placed guidewire may overcome this anatomic obstacle of vessel tortuosity, when placement by other means has proven unsuccessful. (PACE 2013; 36:e41–e44)