title: Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases.
abstract: BACKGROUND
  Securing transvenous left ventricular (LV) pacing leads without an active fixation mechanism in proximal coronary vein (CV) segments is usually challenging and frequently impossible. We investigated how active fixation leads can be safely implanted in this location, how to avoid perforating the free wall of the CV, and how to recognize and respond to perforations.
  
  
  METHODS
  In five patients with no alternative to LV pacing from proximal CV segments, 4 Fr SelectSecure (Medtronic, Minneapolis, MN, USA) leads, which have a fixed helix, were implanted through a modified 6 Fr guide catheter with a pre-shaped tip (Launcher, Medtronic).
  
  
  RESULTS
  Active fixation leads were successfully implanted in proximal CVs in five patients. There were no complications. Acute and chronic pacing thresholds were comparable to those of conventional CV leads. The pre-shaped guide catheter tip remains in close proximity to the myocardial aspect of the CV, directing the lead helix toward a safe implantation site.
  
  
  CONCLUSIONS
  If only proximal CV pacing sites are available, 4 Fr SelectSecure leads can be safely implanted through a modified Launcher guide catheter, avoiding more invasive implantation techniques. Other than venous stenting or implantation of leads with retractable tines, SelectSecure leads are expected to remain extractable.
authors.affiliation: Heart Center NRW, University of Bochum, Bad Oeynhausen, Germany. bhansky@hdz-nrw.de
authors.forename: Bert
authors.initials: B
authors.lastname: Hansky
authors.forename: Juergen
authors.initials: J
authors.lastname: Vogt
authors.forename: Holger
authors.initials: H
authors.lastname: Gueldner
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schulte-Eistrup
authors.forename: Barbara
authors.initials: B
authors.lastname: Lamp
authors.forename: Johannes
authors.initials: J
authors.lastname: Heintze
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003331:Coronary Vessels; D004566:Electrodes; D004867:Equipment Design; D006352:Heart Ventricles; D006801:Humans; D010138:Pacemaker, Artificial