title: Maneuvering balloon occlusion technique to deflect LV lead into a target branch during CRT implantation.
abstract: Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy (DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of a 45-year-old woman with DCM requiring lead placement is presented here. To plan for proper LV lead positioning, CS angiography was obtained through right femoral vein approach with preshaped long sheath (SJM, SL3) and occlusive balloon. For successful implant of LV lead, with no viable alternatives available, the tortuosity of the lateral and posterolateral branch were overcome by advancing and inflating the balloon in the main CS to deflect LV lead into the target branch. A unipolar LV lead (Medtronic 4193) was finally placed in a true posterolateral position with excellent sensing and pacing threshold without phrenic nerve stimulation.
authors.affiliation: Prince Sultan Cardiac Center, P.O. Box 245999, Riyadh, 11312, Saudi Arabia. aafagih@yahoo.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Fagih
authors.forename: Saleh
authors.initials: S
authors.lastname: Al Ghamdi
authors.forename: K
authors.initials: K
authors.lastname: Dagriri
authors.forename: Adil
authors.initials: A
authors.lastname: Ahmed
authors.forename: Ayman
authors.initials: A
authors.lastname: Al Khadra
mesh_terms: D000792:Angiography / Q000379:methods; D021721:Balloon Occlusion / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome