Coronary sinus lead placement via the internal jugular vein in patients with advanced heart failure: a simplified percutaneous approach.
BACKGROUND
Placement of coronary sinus (CS) leads is usually achieved via the left cephalic-axillary-subclavian (CAS) venous system. In some cases, however, such as lack of venous access a right side approach is required. Cannulation of the CS via the right CAS vein is often technically difficult, leaving the right IJ vein as a suitable alternative.


OBJECTIVE
The feasibility of IJ vein as a conduit for transvenous left ventricular (LV) pacing in patients with heart failure (HF) has not been reported.


RESULTS
Between July 2002 and April 2004, we implanted 339 biventricular devices in patients with moderate-to-severe HF. In 15 patients with similar clinical characteristics, in whom the left CAS vein could not be used, the CS leads were placed via the right CAS venous system (n = 5) or the IJ vein (n = 10). The ten patients (6 men and 4 women; age 66 +/- 15 years; LV ejection fraction .19 +/- .07; QRS duration 183 +/- 35 ms) who required IJ CS lead placement had no procedure related complications and all retained appropriate LV pacing and showed significant improvement in HF symptoms after a median follow-up of 12 months (6 to 22 months).


CONCLUSIONS
Thus, in patients with HF for whom the traditional CAS venous approach cannot be used (left side) or is technically difficult (right side), CS leads can be deployed safely via the right IJ vein. In these situations, it seems appropriate to consider this approach prior to the more invasive epicardial approaches.
Pires
Luis A
LA
Heart Rhythm Center, the Department of Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, USA. luis.pires@stjohn.org
Hassan
Sohail A
SA
Johnson
Katrina M
KM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D016896:Treatment Outcome
N Engl J Med. 2002 Jun 13;346(24):1845-53
12063368
J Am Coll Cardiol. 2004 Jul 7;44(1):72-7
15234410
J Am Coll Cardiol. 2003 Oct 15;42(8):1454-9
14563591
Pacing Clin Electrophysiol. 2003 Mar;26(3):747-51
12698677
JAMA. 2003 May 28;289(20):2685-94
12771115
Pacing Clin Electrophysiol. 1999 Nov;22(11):1570-5
10598958
Int J Cardiol. 1992 May;35(2):275-8
1572751
Pacing Clin Electrophysiol. 1996 Jul;19(7):1089-94
8823837
Pacing Clin Electrophysiol. 2000 Nov;23(11 Pt 2):1744-7
11139915
Am J Cardiol. 2004 Jul 1;94(1):59-63
15219510