The Jurdham procedure: endocardial left ventricular lead insertion via a femoral transseptal sheath for cardiac resynchronization therapy pectoral device implantation.
BACKGROUND
Endocardial stimulation of the left ventricle for cardiac resynchronization therapy is a growing field of investigation. Despite the excellent results and absence of significant complications demonstrated thus far in the literature, the lack of a simple, straightforward, and standard technique limits its widespread utilization.


OBJECTIVE
To assess the feasibility, safety, simplicity, and complications of a technique for inserting the left ventricle lead through a femoral transseptal sheath to the pectoral implant site, termed "the Jurdham procedure."


METHODS
We performed the Jurdham procedure in 10 patients (8 men; 60.5 ± 1.8 years) in whom a coronary sinus lead implant had failed. A snared 85-cm standard active fixation endocardial pacing lead was implanted on the left ventricle endocardium through a femoral transseptal sheath with subsequent mobilization of the proximal end of the lead to the prepectoral area via the snare.


RESULTS
Successful implant was achieved in all 10 patients without complications, with excellent acute and chronic pacing parameters. All patients remained on chronic oral anticoagulation therapy without thromboembolic or bleeding complications. No late complications have occurred. All patients have improved at least 1 New York Heart Association functional class and have remained clinically stable during the follow-up term.


CONCLUSIONS
The Jurdham procedure is a reliable, technically easy technique to achieve cardiac resynchronization therapy via the endocardial approach. In our initial experience, there has been an excellent clinical response without significant complications during short-term follow-up. Additional investigation is needed to define the precise indications and limitations of this procedure.
Department of Electrophysiology, Presidente Perón Hospital, Buenos Aires, Argentina. belencwajg@yahoo.com
Benjamin
B
Elencwajg
Néstor
N
López Cabanillas
Eduardo Luis
EL
Cardinali
José Luis
JL
Barisani
Jorge
J
Trainini
Avi
A
Fischer
Seth
S
Worley
D000328:Adult; D000368:Aged; D001367:Axillary Vein; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D005471:Fluoroscopy; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D013350:Subclavian Vein; D017211:Treatment Failure; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery; D054088:Ventricular Septum / Q000503:physiopathology / Q000601:surgery