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CRT delivery systems based on guide support for LV lead placement

      Despite improvements in LV pacing leads, their placement continues to be limited by the coronary venous anatomy. Frequently, the angioplasty wire does not provide adequate support to advance the LV lead into the vein. However, a guiding catheter preshaped to fit into the ostium of the target can easily provide the required support.
      • Worley S.J.
      • Leon A.
      • Wilkoff B.L.
      Anatomy and implantation techniques for biventricular devices.
      • Worley S.J.
      Left ventricular lead implantation.
      Many implanting physicians are reluctant to adopt preshaped guides for direct LV lead delivery because of lack of familiarity with the approach to open lumen catheter manipulation and contrast injection. However, recognizing the importance of guide support for LV lead delivery, implanting physicians are moving toward a more interventional approach. In anticipation of implanting physicians adopting these new techniques, all of the device companies and several independent vendors have guide-support-based delivery systems in development. This report describes the use of guide support and provides a comparison of the available or soon to be available systems.

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