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Transseptal Left Ventricular Lead Placement Using Snare Technique
Author(s) -
WRIGHT GARY A.,
TOMLINSON DAVID R.,
LINES IAN,
DAVIES EDWARD J.,
HAYWOOD GUY A.
Publication year - 2012
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.1540-8159.2012.03498.x
Subject(s) - medicine , coronary sinus , cardiac resynchronization therapy , interatrial septum , cardiology , ventricle , implant , lead (geology) , coronary vein , surgery , heart failure , left atrium , ejection fraction , atrial fibrillation , geomorphology , geology
Background: Coronary sinus (CS) lead placement for cardiac resynchronization therapy has a failure rate of ∼5–10%. Here we describe a way of implanting an endocardial left ventricular (LV) lead via a transseptal puncture (TSP), using a GooseNeck snare and active fixation lead.Methods: Three male patients (67–83 years) with failed or extracted epicardial LV leads implanted via the CS had an endocardial LV lead implanted. TSP was performed via a femoral vein. The active fixation pacing lead was advanced to the right atrium from a subclavian vein. A GooseNeck snare was passed via the TSP sheath and used to grasp the tip of the pacing lead. The sheath, GooseNeck snare, and pacing lead tip were then passed to the left atrium by sliding the system up the TSP guidewire and across the interatrial septum before deflecting the lead to permit implantation in the left ventricle.Results: Successful implantation was performed in all patients with an LV implant time of 25–55 minutes.Conclusion: The use of a GooseNeck snare via a deflectable transseptal sheath represents a reliable alternative method for endocardial LV lead placement in patients with failed CS LV lead implantation. (PACE 2012; 35:1248–1252)