title: [Double-wire technique for implanting a left ventricular venous lead in patients with complicated coronary venous anatomy].
abstract: OBJECTIVE
  Occasionally, implanting a left ventricular pacing electrode for cardiac resynchronization therapy via the coronary sinus may be complicated by the presence of anatomical structures that obstruct the access to the target vein. Our objective was to report on experience using a double-wire technique for implanting left ventricular venous leads gained at the Dr Negrín Hospital in Gran Canaria, Spain.
  
  
  METHODS
  In 20 (12%) of 170 consecutive patients (67 [9] years, 72% male) undergoing implantation of a cardiac resynchronization device, a second parallel hydrophilic guidewire had to be used during lead implantation in the target vein as implantation was impossible without using this technique.
  
  
  RESULTS
  Implantation using a conventional approach was impossible because there was severe tortuosity at the vessel entrance in five patients (25%), a sharp angle at the entrance to the target vein in seven (35%), a venous valve at the vessel entrance in eight (40%), and, finally, poor support for the guiding catheter in four (20%), due to the presence of either a fenestrated Thebesian valve (two patients) or a restrictive Vieussens valve (two patients) that blocked passage of the guiding catheter or electrode. In four patients (20%), there was more than one factor. In all these cases, implantation was achieved in the target vein without complications after passage of a second hydrophilic guidewire.
  
  
  CONCLUSIONS
  The use of a second parallel guidewire (i.e., the double-wire technique) provides a safe and effective way of implanting left ventricular venous pacing electrodes in patients with anatomical complications.
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain. elenaarbelo@secardiologia.es
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Medina
authors.forename: José
authors.initials: J
authors.lastname: Bolaños
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Quintana
authors.forename: Eduardo
authors.initials: E
authors.lastname: Caballero
authors.forename: Antonio
authors.initials: A
authors.lastname: Delgado
authors.forename: Francisco
authors.initials: F
authors.lastname: Melián
authors.forename: Celestina
authors.initials: C
authors.lastname: Amador
authors.forename: Javier
authors.initials: J
authors.lastname: Suárez de Lezo
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002303:Cardiac Output, Low / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D003330:Coronary Vessel Anomalies / Q000150:complications*; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male