title: Femoral implantation and pull through as an adjunct to traditional methods in cardiac resynchronization therapy.
abstract: We have described the use of femoral access followed by pull through of the lead to a pectoral position to circumvent difficulty in implanting a left ventricular (LV) lead by standard methods.
  
  
  
  The purpose of this study was to establish the effect of femoral implantation and pull through on the overall rate of success in percutaneous implantation of LV leads.
  
  
  
  We collected data prospectively in all attempts at LV lead implantation from the time that we envisioned the femoral pull-through approach.
  
  
  
  In the 6 years to September 30, 2014, our group attempted to implant a new LV lead in 736 patients, including 16 who previously had failed attempts by other groups. A standard superior approach was successful in 726 of 731 patients (99.3%) in whom it was attempted. In 5 patients (0.7%), we failed to deliver a lead from a superior approach; in 5 of 16 patients, with previous failed attemtps (31%), we judged that those attempts had been exhaustive. In all 10 cases, LV lead placement was achieved from a femoral approach, with the procedure time being 186 ± 65 minutes. In the first case attempted, the pull through failed; the lead was tunneled to the pectoral generator. In 1 case, the coronary sinus was found to be occluded at the ostium: a transseptal approach was used with the subsequent pull through. No complication occurred. At 22.3 ± 18.5 months after the implantation, all systems implanted by a femoral approach continued to function.
  
  
  
  Used as an adjunct to standard methods, the femoral access and pull through method allows percutaneous LV lead placement in virtually all cases.
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom.
authors.forename: Hanney
authors.initials: H
authors.lastname: Gonna
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom.
authors.forename: Giulia
authors.initials: G
authors.lastname: Domenichini
authors.affiliation: Department of Cardiology, Royal Surrey County Hospital, Guildford, United Kingdom.
authors.forename: Zia
authors.initials: Z
authors.lastname: Zuberi
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom.
authors.forename: Shaumik
authors.initials: S
authors.lastname: Adhya
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom.
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Anderson
authors.affiliation: Department of Cardiology, St Peter's Hospital, Chertsey, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Beeton
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom; Department of Cardiology, St Peter's Hospital, Chertsey, United Kingdom.
authors.forename: Paramdeep S
authors.initials: PS
authors.lastname: Dhillon
authors.affiliation: Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, United Kingdom; Department of Cardiology, St Peter's Hospital, Chertsey, United Kingdom. Electronic address: mark_m_gallagher@hotmail.com.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Gallagher
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D006113:United Kingdom
keywords: Endocardial left ventricular pacing; Femoral approach; Left ventricular pacing; Pull through; Surgical left ventricular pacing; Transseptal left ventricular pacing