Novel steerable telescoping catheter system for implantation of left ventricular pacing leads.
Advances in left ventricular transvenous lead delivery systems for biventricular pacing are leading to more refined techniques, shorter procedure times and higher implant success rates. Despite these advances, the inability to successfully cannulate the coronary sinus and deliver a lead to a distal location are still major causes of prolonged procedures times and implant failures. The pathophysiologic process of heart failure results in dilatation of the right atrium as well as other morphological changes in cardiac anatomy. Additionally, cannulation can be further complicated by congenital anomalous cardiac anatomy. This report describes the implant of a biventricular pacing system using a novel, steerable 7 French catheter system developed to aid in the cannulation of the coronary sinus ostium and its venous branches. The steerable catheter is used in conjunction with a 9 French braided sheath and guide-wire to create a telescoping system. The use of new tools and methods as described provides insight into available options for left ventricular transvenous lead implantation and dealing with difficult anatomy.
Geske
Jeffrey B
JB
Mayo Medical School, Rochester, Medtronic, Inc., Minneapolis, MN, USA.
Goldstein
Robert N
RN
Stambler
Bruce S
BS
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D004867:Equipment Design; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male
Circulation. 1989 Apr;79(4):845-53
2924415
J Interv Card Electrophysiol. 2003 Dec;9(3):343-51
14618054
Rev Cardiovasc Med. 2003 Summer;4(3):142-9
12949443
N Engl J Med. 2002 Jun 13;346(24):1845-53
12063368
Circulation. 2001 Dec 18;104(25):3026-9
11748094
J Interv Card Electrophysiol. 2004 Jun;10(3):227-30
15133359
Am Heart J. 2002 Jun;143(6):1085-91
12075267
Pacing Clin Electrophysiol. 1998 Nov;21(11 Pt 1):2021-4
9826852
Am J Cardiol. 2000 Nov 2;86(9A):157K-164K
11084117
Br Heart J. 1992 Oct;68(4):403-7
1449925
Rev Cardiovasc Med. 2003;4 Suppl 2:S38-46
12776012
Am Heart J. 2000 Dec;140(6):862-70
11099989
Br Heart J. 1991 Dec;66(6):443-7
1772710