title: Retrograde buddy wire technique for coronary sinus lead placement--an approach to overcome coronary vein angulation.
abstract: Implantation of a left ventricular pacing lead via the coronary sinus to deliver cardiac resynchronization therapy has become standard therapy for patients with New York Heart Association (NYHA) Class III or IV heart failure and significant intraventricular conduction delay. Biventricular pacing has been shown to provide both symptomatic and mortality benefit in appropriately selected patients. There is significant variability in the anatomy of the coronary sinus and the epicardial coronary venous system. Although a suitable candidate vein may be identified during coronary venography, efforts toward successful guidewire placement or lead placement may be hampered by anatomic obstacles. In this case report, we provide a solution to overcome severe tortuosity encountered at the vein-coronary sinus junction and angulation of the proximal vein. The use of a second coronary sinus sheath and a retrogradely placed guidewire may overcome this anatomic obstacle of vessel tortuosity, when placement by other means has proven unsuccessful.
authors.affiliation: New Jersey Arrhythmia Associates, division of New Jersey Cardiology Associates, West Orange, New Jersey 07052, USA. dpdobesh@gmail.com
authors.forename: David P
authors.initials: DP
authors.lastname: Dobesh
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Costeas
authors.forename: Mandhavi
authors.initials: M
authors.lastname: Pamidi
authors.forename: Marc
authors.initials: M
authors.lastname: Roelke
authors.forename: Donald G
authors.initials: DG
authors.lastname: Rubenstein
mesh_terms: D000368:Aged; D003331:Coronary Vessels / Q000601:surgery*; D004567:Electrodes, Implanted; D006333:Heart Failure / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome