title: Wire Externalisation for Left Ventricular Lead Placement in Cardiac Resynchronisation Therapy: A Step-by-step Guide.
abstract: BACKGROUND
  Left ventricular (LV) lead implantation for CRT can be challenging. We describe the technique of wire externalisation to enable posterolateral (PL) LV lead placement and give case examples to illustrate its use.
  
  
  METHODS
  The technique includes: The externalised guidewire provides excellent support for antegrade or retrograde advancement of the LV lead.
  
  
  RESULTS
  Wire externalisation has been used to overcome PL branch tortuosity, persistent left SVC or acute angulation of the CS ostium. Antegrade delivery or retrograde delivery is possible but there may be an additional need for balloon angioplasty to facilitate lead advancement. There have been no complications at implant or 30-day follow-up.
  
  
  CONCLUSIONS
  The wire externalisation technique can facilitate optimal LV lead placement in difficult CRT cases.
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand; Derriford Hospital, Plymouth, UK. Electronic address: guyfurniss@yahoo.co.uk.
authors.forename: Guy O
authors.initials: GO
authors.lastname: Furniss
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Liang
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jimenez
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Scott
authors.initials: S
authors.lastname: Harding
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male