Abstract
Background
Trans-septal endocardial left ventricular (LV) lead placement has been used for LV pacing in a small number of patients, partially due to difficulty in achieving the aim in practice.
Methods
Based on analysis of the pre-existent techniques and exploitation of the latest developments in lead technologies, a new technique for trans-septal endocardial LV lead placement was devised. The inter-atrial septum (IAS) was punctured and a guide wire placed in the left atrium (LA) from the right femoral vein. A SelectSite® C304-S59 catheter (Medtronic) was introduced from an upper body vein and deflected so that its tip approached the IAS puncture as marked by the guide wire already in the LA. The dilator supplied with the SelectSite® catheter was used to engage the IAS puncture and pass a guide wire into the LA. The dilator was advanced over the guide wire, and then the catheter over the dilator, into the LA. The catheter was undeflected and torqued clockwise to prolapse the catheter-dilator-guide wire assembly into the LV cavity. The dilator-guide wire assembly was exchanged for a SelectSecure® 3830–69 cm lead, which was deployed on the LV endocardial surface. The catheter was withdrawn entirely into the right atrium before it was slit.
Results
The new technique was successfully implemented in a patient who required cardiac resynchronization therapy.
Conclusions
The new technique appears more streamlined and efficient than the pre-existent techniques and may make trans-septal endocardial LV lead placement a more clinically utilized alternative to coronary sinus and surgical epicardial LV lead placement.
Similar content being viewed by others
References
Cazeau, S., Leclercq, C., Lavergne, T., Walker, S., Varma, C., Linde, C., et al. (2001). Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. The New England Journal of Medicine, 344, 873–880.
Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). Cardiac resynchronization in chronic heart failure. The New England Journal of Medicine, 346, 1845–1853.
Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. The New England Journal of Medicine, 352, 1539–1549.
McAlister, F. A., Ezekowitz, J., Hooton, N., Vandermeer, B., Spooner, C., Dryden, D. M., et al. (2007). Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. Journal of the American Medical Association, 297, 2502–2514.
Leon, A. R., Abraham, W. T., Curtis, A. B., Daubert, J. P., Fisher, W. G., Gurley, J., et al. (2005). Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2, 000 patients from a multicenter study program. Journal of the American College of Cardiology, 20(46), 2348–2356.
Worley, S. J. (2008). Implant venoplasty: dilation of subclavian and coronary veins to facilitate device implantation: indications, frequency, methods, and complications. Journal of Cardiovascular Electrophysiology, 19, 1004–1007.
Kowalski, O., Lenarczyk, R., Prokopczuk, J., Pruszkowska-Skrzep, P., Zielinska, T., Sredniawa, B., et al. (2006). Effect of percutaneous interventions within the coronary sinus on the success rate of the implantations of resynchronization pacemakers. Pacing and Clinical Electrophysiology, 29, 1075–1080.
Kowalski, O., Prokopczuk, J., Lenarczyk, R., Pruszkowska-Skrzep, P., Polonski, L., & Kalarus, Z. (2006). Coronary sinus stenting for the stabilization of left ventricular lead during resynchronization therapy. Europace, 8, 367–370.
Worley, S. J., Gohn, D. C., & Pulliam, R. W. (2008). Focused force coronary venoplasty to eliminate a refractory stenosis preventing LV lead placement in two patients. Pacing and Clinical Electrophysiology, 31, 1503–1505.
Cesario, D. A., Shenoda, M., Brar, R., & Shivkumar, K. (2006). Left ventricular lead stabilization utilizing a coronary stent. Pacing and Clinical Electrophysiology, 29, 427–428.
de Cock, C. C., Jessurun, E. R., Allaart, C. A., & Visser, C. A. (2004). Repetitive intraoperative dislocation during transvenous left ventricular lead implantation: usefulness of the retained guidewire technique. Pacing and Clinical Electrophysiology, 27, 1589–1593.
Zanon, F., Baracca, E., Pastore, G., Aggio, S., Rigatelli, G., Dondina, C., et al. (2006). Implantation of left ventricular leads using a telescopic catheter system. Pacing and Clinical Electrophysiology, 29, 1266–1272.
Vogt, J., Schwarz, T., Gras, D., Sperzel, J., Ritter, P., de, V. W., et al. (2007). The use of telescoping guide catheters for coronary sinus cannulation and sub-selecting tributaries in left ventricular lead placement. Journal of Interventional Cardiac Electrophysiology, 19, 61–68.
Perzanowski, C., & Gilliam, F. R. (2005). The buddy wire technique: accessing lateral coronary veins while maintaining coronary sinus position. Journal of Interventional Cardiac Electrophysiology, 13, 231–234.
Chierchia, G. B., Geelen, P., Rivero-Ayerza, M., & Brugada, P. (2005). Double wire technique to catheterize sharply angulated coronary sinus branches in cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 28, 168–170.
Lopez, J. A., & Hernandez, E. (2007). Transvenous implantation of a coronary sinus lead for left ventricular pacing after cutting balloon angioplasty. Pacing and Clinical Electrophysiology, 30, 568–570.
Chauhan, K., Sayad, D., Bowerman, R., & Barold, S. S. (2008). Coronary vein angioplasty with noncompliant balloon for resistant coronary vein stenosis during left ventricular lead implantation. Pacing and Clinical Electrophysiology, 31, 251–252.
Mair, H., Jansens, J. L., Lattouf, O. M., Reichart, B., & Dabritz, S. (2003). Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach. The Heart Surgery Forum, 6, 412–417.
Mair, H., Sachweh, J., Meuris, B., Nollert, G., Schmoeckel, M., Schuetz, A., et al. (2005). Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. European Journal of Cardio-Thoracic Surgery, 27, 235–242.
Navia, J. L., Atik, F. A., Grimm, R. A., Garcia, M., Vega, P. R., Myhre, U., et al. (2005). Minimally invasive left ventricular epicardial lead placement: surgical techniques for heart failure resynchronization therapy. The Annals of Thoracic Surgery, 79, 1536–1544.
Gabor, S., Prenner, G., Wasler, A., Schweiger, M., Tscheliessnigg, K. H., & Smolle-Juttner, F. M. (2005). A simplified technique for implantation of left ventricular epicardial leads for biventricular re-synchronization using video-assisted thoracoscopy (VATS). European Journal of Cardio-Thoracic Surgery, 28, 797–800.
Doll, N., Piorkowski, C., Czesla, M., Kallenbach, M., Rastan, A. J., Arya, A., et al. (2008). Epicardial versus transvenous left ventricular lead placement in patients receiving cardiac resynchronization therapy: results from a randomized prospective study. The Thoracic and Cardiovascular Surgeon, 56, 256–261.
Jutley, R. S., Waller, D. A., Loke, I., Skehan, D., Ng, A., Stafford, P., et al. (2008). Video-assisted thoracoscopic implantation of the left ventricular pacing lead for cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 31, 812–818.
Tomaske, M., Gerritse, B., Kretzers, L., Pretre, R., Dodge-Khatami, A., Rahn, M., et al. (2008). A 12-year experience of bipolar steroid-eluting epicardial pacing leads in children. The Annals of Thoracic Surgery, 85, 1704–1711.
Jais, P., Douard, H., Shah, D. C., Barold, S., Barat, J. L., & Clementy, J. (1998). Endocardial biventricular pacing. Pacing and Clinical Electrophysiology, 21, 2128–2131.
Jais, P., Takahashi, A., Garrigue, S., Yamane, T., Hocini, M., Shah, D. C., et al. (2000). Mid-term follow-up of endocardial biventricular pacing. Pacing and Clinical Electrophysiology, 23, 1744–1747.
Leclercq, F., Hager, F. X., Macia, J. C., Mariottini, C. J., Pasquie, J. L., & Grolleau, R. (1999). Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure. Pacing and Clinical Electrophysiology, 22, 1570–1575.
Ji, S., Cesario, D. A., Swerdlow, C. D., & Shivkumar, K. (2004). Left ventricular endocardial lead placement using a modified transseptal approach. Journal of Cardiovascular Electrophysiology, 15, 234–236.
Pasquie, J. L., Massin, F., Macia, J. C., Gervasoni, R., Bortone, A., Cayla, G., et al. (2007). Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure. Pacing and Clinical Electrophysiology, 30(Suppl 1), S31–3.:S31–S33.
van Gelder, B. M., Scheffer, M. G., Meijer, A., & Bracke, F. A. (2007). Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy. Heart Rhythm, 4, 454–460.
Nuta, B., Lines, I., MacIntyre, I., & Haywood, G. A. (2007). Biventricular ICD implant using endocardial LV lead placement from the left subclavian vein approach and transseptal puncture via the transfemoral route. Europace, 9, 1038–1040.
Konings, T. C., Koolbergen, D. R., Bouma, B. J., Groenink, M., & Mulder, B. J. (2008). Iatrogenic perforation of the posterior mitral valve leaflet: a rare complication of pacemaker lead placement. Journal of the American Society of Echocardiography, 21, 512–517.
Gammage, M. D., Lieberman, R. A., Yee, R., Manolis, A. S., Compton, S. J., Khazen, C., et al. (2006). Multi-center clinical experience with a lumenless, catheter-delivered, bipolar, permanent pacemaker lead: implant safety and electrical performance. Pacing and Clinical Electrophysiology, 29, 858–865.
O'Donnell, D., Nadurata, V., Hamer, A., Kertes, P., & Mohamed, U. (2005). Bifocal right ventricular cardiac resynchronization therapies in patients with unsuccessful percutaneous lateral left ventricular venous access. Pacing and Clinical Electrophysiology, 28(Suppl 1), S27–30.:S27–S30.
Res, J. C., Bokern, M. J., de Cock, C. C., van, L. T., Bronzwaer, P. N., & Spierenburg, H. A. (2007). The BRIGHT study: bifocal right ventricular resynchronization therapy: a randomized study. Europace, 9, 857–861.
Obel, O., Mansour, M., Picard, M., Ruskin, J., & Keane, D. (2004). Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing and Clinical Electrophysiology, 27, 1411–1414.
Hammerstingl, C., Lickfett, L., Jeong, K. M., Troatz, C., Wedekind, J. A., Tiemann, K., et al. (2006). Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—an underestimated risk? American Heart Journal, 152, 362–365.
Rillig, A., Meyerfeldt, U., Birkemeyer, R., Treusch, F., Kunze, M., & Jung, W. (2008). Persistent iatrogenic atrial septal defect after pulmonary vein isolation : incidence and clinical implications. Journal of Interventional Cardiac Electrophysiology, 22, 177–181.
Korkeila, P. J., Saraste, M. K., Nyman, K. M., Koistinen, J., Lund, J., & Juhani Airaksinen, K. E. (2006). Transesophageal echocardiography in the diagnosis of thrombosis associated with permanent transvenous pacemaker electrodes. Pacing and Clinical Electrophysiology, 29, 1245–1250.
van Rooden, C. J., Molhoek, S. G., Rosendaal, F. R., Schalij, M. J., Meinders, A. E., & Huisman, M. V. (2004). Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. Journal of Cardiovascular Electrophysiology, 15, 1258–1262.
Karavidas, A., Lazaros, G., Matsakas, E., Kouvousis, N., Samara, C., Christoforatou, E., et al. (2004). Early pacemaker lead thrombosis leading to massive pulmonary embolism. Echocardiography (Mount Kisco, N.Y.), 21, 429–432.
Huang, W. M., Xin, Z. P., & Tung, C. L. (1980). An unusual electrocardiographic pattern of left ventricular endocardial pacing. Pacing and Clinical Electrophysiology, 3, 597–599.
Shmuely, H., Erdman, S., Strasberg, B., & Rosenfeld, J. B. (1992). Seven years of left ventricular pacing due to malposition of pacing electrode. Pacing and Clinical Electrophysiology, 15, 369–372.
van Erckelens, F., Sigmund, M., Lambertz, H., Kreis, A., Reupcke, C., & Hanrath, P. (1991). Asymptomatic left ventricular malposition of a transvenous pacemaker lead through a sinus venosus defect: follow-up over 17 years. Pacing and Clinical Electrophysiology, 14, 989–993.
van Gelder, B. M., Bracke, F. A., Oto, A., Yildirir, A., Haas, P. C., Seger, J. J., et al. (2000). Diagnosis and management of inadvertently placed pacing and ICD leads in the left ventricle: a multicenter experience and review of the literature. Pacing and Clinical Electrophysiology, 23, 877–883.
Trohman, R. G., Wilkoff, B. L., Byrne, T., & Cook, S. (1991). Successful percutaneous extraction of a chronic left ventricular pacing lead. Pacing and Clinical Electrophysiology, 14, 1448–1451.
de Cock, C. C., van Campen, C. M., Kamp, O., & Visser, C. A. (2003). Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead. Europace, 5, 195–197.
Orlov, M. V., Messenger, J. C., Tobias, S., Smith, C. W., Waider, W., Winters, R., et al. (1999). Transesophageal echocardiographic visualization of left ventricular malpositioned pacemaker electrodes: implications for lead extraction procedures. Pacing and Clinical Electrophysiology, 22, 1407–1409.
Burke, M. C., Morton, J., Lin, A. C., Tierney, S., Desai, A., Hong, T., et al. (2005). Implications and outcome of permanent coronary sinus lead extraction and reimplantation. Journal of Cardiovascular Electrophysiology, 16, 830–837.
Fish, J. M., Di Diego, J. M., Nesterenko, V., & Antzelevitch, C. (2004). Epicardial activation of left ventricular wall prolongs QT interval and transmural dispersion of repolarization: implications for biventricular pacing. Circulation, 109, 2136–2142.
Garrigue, S., Jais, P., Espil, G., Labeque, J. N., Hocini, M., Shah, D. C., et al. (2001). Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using Doppler tissue imaging in patients with heart failure. The American Journal of Cardiology, 88, 858–862.
Mykytsey, A., Maheshwari, P., Dhar, G., Razminia, M., Zheutlin, T., Wang, T., et al. (2005). Ventricular tachycardia induced by biventricular pacing in patient with severe ischemic cardiomyopathy. Journal of Cardiovascular Electrophysiology, 16, 655–658.
Nayak, H. M., Verdino, R. J., Russo, A. M., Gerstenfeld, E. P., Hsia, H. H., Lin, D., et al. (2008). Ventricular tachycardia storm after initiation of biventricular pacing: incidence, clinical characteristics, management, and outcome. Journal of Cardiovascular Electrophysiology, 19, 708–715.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lau, E.W. A streamlined technique of trans-septal endocardial left ventricular lead placement. J Interv Card Electrophysiol 26, 73–81 (2009). https://doi.org/10.1007/s10840-009-9395-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-009-9395-6