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Hands on| Volume 6, ISSUE 9, P1383-1387, September 2009

CRT delivery systems based on guide support for LV lead placement

Published:May 12, 2009DOI:https://doi.org/10.1016/j.hrthm.2009.04.038
CRT delivery systems based on guide support for LV lead placement
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      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.
      in: Ellenbogen K.A. Kay G.N. Wilkoff B.L. Device Therapy for Congestive Heart Failure. Saunders, Philadelphia2004
      , 
      • Worley S.J.
      Left ventricular lead implantation.
      in: Ellenbogen K.A. Kay G.N. Lau C.P. Wilkoff B.L. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy. 3rd Edition. Saunders, Philadelphia2007
      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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      References

        • Worley S.J.
        • Leon A.
        • Wilkoff B.L.
        Anatomy and implantation techniques for biventricular devices.
        in: Ellenbogen K.A. Kay G.N. Wilkoff B.L. Device Therapy for Congestive Heart Failure. Saunders, Philadelphia2004
        View in Article
        • Worley S.J.
        Left ventricular lead implantation.
        in: Ellenbogen K.A. Kay G.N. Lau C.P. Wilkoff B.L. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy. 3rd Edition. Saunders, Philadelphia2007
        View in Article
        • Gabor Z.
        • Duray G.Z.
        • Hohnloser S.H.
        • Israel C.W.
        Coronary sinus side branches for cardiac resynchronization therapy: prospective evaluation of availability, implant success, and procedural determinants.
        J Cardiovasc Electrophysiol. 2008; 19: 489-494
        View in Article
        • D'ivernois C.
        • Lesage J.
        • Blanc P.
        Where are the left ventricular leads really implanted?.
        Pacing Clin Electrophysiol. 2008; 31: 554-559
        View in Article

      Article info

      Publication history

      Published online: May 12, 2009
      Accepted: April 29, 2009
      Received: April 16, 2009

      Footnotes

      Dr. Worley receives compensation in various forms from Boston Scientific, Medtronic, Oscor, Pressure Products, and St. Jude Medical.

      Identification

      DOI: https://doi.org/10.1016/j.hrthm.2009.04.038

      Copyright

      © 2009 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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