Cor Vasa 2022, 64(4):374-379 | DOI: 10.33678/cor.2021.097

A Solution Trick: Implantation of Coronary Sinus Lead Without Delivery System, A Case Series Study

Ersin Doğanözü

9 Mayis State Hospital, Department of Cardiology, Ankara Hospital, Turkey

Background: Cardiac resynchronization therapy (CRT) is one of the most challenging procedure of invasive cardiology. Variations of coronary sinus anatomy and complexity of the procedure may result in unsuccessful implantation or may need surgical implantation of coronary sinus lead.

Methods: This is a retrospective observational case study. The patients were enrolled from the CRT patients who were implanted LV lead without delivery sheath of cardiology department between July 2020 and March 2021. Patient information was obtained by retrospective file scanning. Description of tips of the trick: Multipurpose (MP) or any diagnostic catheter is pushed forward to the right atrium via a tearable safe sheath. Coronary sinus (CS) ostium is cannulated by the catheter. CS angiography is performed. Stiff wire (ASAHI Grand Slam, 0.014 inch, 180 cm) is directly advanced into the target vessel or a soft wire is used for selective cannulation of targeted tributaries by the catheter and soft wire is exchanged with the stiff one. The catheter is extracted over stiff guidewire. LV lead is advanced over stiff guidewire to CS. LV lead is advanced into the target cardiac vein and stiff wire is extracted.

Results: All patients were male, one of them is 80 years old and the others 50-70 ages old. Four patients were suffering from ischemic cardiomyopathy and one from non-ischemic cardiomyopathy. Four patients were inpatients, one patient was outpatient. Procedure was performed from right pectoral area in three patients. In three of the five patients, conservative technique was planned, and we were unable to cannulate CS or to go to a very low posterior cardiac vein with delivery sheath. We used descripted trick to cannulate CS or targeted vein as a problem solver. One week and 1-month follow-ups of the patients werer uneventful.

Conclusions: Grand Slam wire provides back up to CS lead without delivery system and it can help to implant LV lead. We need more case series and randomized studies to understand safety and efficacy of the new trick.

Keywords: Congestive heart failure, CRT, Defibrillation, ICD

Received: July 11, 2021; Revised: August 7, 2021; Accepted: August 10, 2021; Published: September 1, 2022  Show citation