Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Implantation D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-098 - Interventional Approach To Left Ventricular Lead Implantation (ID 436)

 N. Alexander: Nothing relevant to disclose.


Background: Anatomic variability of the coronary venous system frequently hinders left ventricular lead placement using traditional tools and techniques. Interventional tools and techniques have been developed to improve the success of cardiac resynchronization therapy.
Objective: To describe the success of employing interventional tools and techniques in patients (pts) with implant failure as well as describe the tools and techniques employed.
Methods: We reviewed the data on 187 patients with previously unsuccessful LV lead placement, who had a subsequent implant attempt using interventional tools and techniques from June 2017 through November 2019.
Results: 178 of 187 patients were implanted successfully. The following interventional techniques were judged primary: 1. Vein selector enhanced sub-selector (31 pts) 2. Snare - ortho/antidromic (25 pts) 3. Support wire technique (20 pts) 4. Anchor balloon (6 pts) 5. Coronary branch venoplasty (6 pts); 6. Subclavian venoplasty (40 pts). Two patients with CS atresia were implanted via a patent vein of Marshall. In 138 cases, two interventional techniques were employed (e.g. subclavian venoplasty & vein selector). Implant failure resulted from: high thresholds in all targets (5 pts), CS atresia & unroofed CS with occluded vein of Marshall (2 pt), epicardial fat everywhere with high thresholds (1 pt), and failed venoplasty due to significant obstruction (1 pt).
Conclusion: Use of interventional techniques including vein selectors, snaring, coronary venoplasty, & the anchor balloon makes LV lead implantation successful in the vast majority of prior implant failures even those with CS atresia. High threshold’s in all target veins & CS atresia with no vein of Marshall remain rare insurmountable obstacles.