title: Transseptal left ventricular endocardial pacing: preliminary experience from a femoral approach with subclavian pull-through.
abstract: OBJECTIVE
  Coronary sinus (CS) lead placement for transvenous cardiac resynchronization therapy (CRT) even combined with transseptal left ventricular (LV) endocardial implantation from a superior approach still does not have 100% success rate. The aim of this study was to assess the feasibility of a femoral transseptal endocardial LV approach pacing in patients in whom a transvenous CS or a transseptal LV endocardial implantation with a superior approach had failed. We report our first experience with LV endocardial lead placement for CRT with a femoral transseptal technique followed by intravascular pull-through to the pectoral location.
  
  
  RESULTS
  In 11 patients, 10 males (61.5 ± 9.5 years) with failed CS implant (four patients) or repeated CS lead malfunction (seven patients), a 4.1 French active fixation lead was implanted endocardially in the left ventricle employing a femoral approach using an 8F transseptal sheath combined with a hooked 6F catheter. After successful implantation, the lead was pulled through from the femoral insertion site to the pectoral device location. The LV endocardial implantation was successfully performed in all patients. Stimulation threshold was 0.62 ± 0.33 V, lead impedance 825 ± 127 Ω, and R wave 12.8 ± 8.3 mV. Threshold and lead impedance were stable during follow-up, which varied from 1 to 6 months. No dislodgements were observed and there were no thrombo-embolic events during follow-up.
  
  
  CONCLUSIONS
  This technique for LV endocardial lead implantation is an alternative for failed CS and superior transseptal attempts using standard techniques and equipment. It is also applicable for pacing sites that are more easily reached from a femoral approach.
authors.affiliation: Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. carlgr@cze.nl
authors.forename: Berry M
authors.initials: BM
authors.lastname: van Gelder
authors.forename: Patrick
authors.initials: P
authors.lastname: Houthuizen
authors.forename: Frank A
authors.initials: FA
authors.lastname: Bracke
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D054326:Coronary Sinus; D004567:Electrodes, Implanted; D004699:Endocardium / Q000503:physiopathology*; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013350:Subclavian Vein; D017211:Treatment Failure; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D054088:Ventricular Septum / Q000503:physiopathology*