title: Veno-venous loop through coronary sinus for LV lead placement during cardiac resynchronization therapy.
abstract: Left ventricular lead placement in the appropriate branch of coronary sinus is the key to successful cardiac resynchronization therapy (CRT) and this step is technically challenging. We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized. Over this loop, the left ventricular lead of the CRT-D device was implanted successfully. This novel approach can be used to successfully implant the LV lead in difficult to implant situations, obviating the need for thoracotomy or other methods of LV lead implantation.
authors.affiliation: Professor, Department of Cardiology, Dr. Ram Manohar Lohia Hospital & PGIMER, New Delhi 110001, India. Electronic address: ranjitknath@yahoo.com.
authors.forename: Ranjit Kumar
authors.initials: RK
authors.lastname: Nath
authors.affiliation: Associate Professor, Department of Cardiology, Dr. Ram Manohar Lohia Hospital & PGIMER, New Delhi 110001, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Raj
authors.affiliation: Senior Resident, Department of Cardiology, Dr. Ram Manohar Lohia Hospital & PGIMER, New Delhi 110001, India.
authors.forename: C
authors.initials: C
authors.lastname: Parvatagouda
authors.affiliation: Professor and Head, Department of Cardiology, Dr. Ram Manohar Lohia Hospital & PGIMER, New Delhi 110001, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Pandit
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D054326:Coronary Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D014683:Vena Cava, Superior / Q000601:surgery*
keywords: Coronary sinus; LV lead; Snare; Veno-venous loop