title: Retaining of PTCA guide wire in the left ventricular lead and subsequent application of epicardial electrode when CRT-D implantation in a patient with severe heart failure and persistent left superior vena cava: a case report.
abstract: OBJECTIVE
  One patient with severe heart failure (LV 92 mm, EF 28%) was treated by cardiac resynchronization therapy (CRT).
  
  
  METHODS
  During the operation, it was found that double superior vena cava coexisted, and selective coronary venography cannot clearly show every branch. It was difficult to push ventriculus sinister electrode to sideward vein, so the electrode was released to far end of frontal septal branch along great cardiac vein.
  
  
  RESULTS
  However, because of insufficient braced force of ventriculus sinister electrode, 0.014 PTCA guide wire was detained in the electrode. 2 years later, two spots of PTCA guide wire retained in ventriculus sinister electrode broke in atrium dextrum, so the implantation of epicardial electrode was conducted.
  
  
  CONCLUSIONS
  After the operation, heart failure was relieved. After 43 months, the battery of pacemaker depleted, so the pacemaker was changed. The effect since follow-up visit was good, LV decreased to 86 mm, EF increased to 32%, and SPWMD time limit shortened from 147 ms to 45 ms. The therapeutic experience of this patient indicated that the effect of detaining PTCA guide wire to enhance braced force in implantation of ventriculus sinister is unreliable and inappropriate to be advocated.
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Pei-Pei
authors.initials: PP
authors.lastname: Hou
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Liu
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Qu
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Jin
authors.initials: J
authors.lastname: Meng
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Heart Center, The People's Hospital of Liaoning Province Shenyang 110016, P. R. China.
authors.forename: Zhi-Lin
authors.initials: ZL
authors.lastname: Miao
keywords: Cardiac resynchronization therapy; PTCA guide wire; epicardial left ventricular lead; persistent left superior vena cava