Use of a modified introducer sheath with a side-hole to improve access to left ventricular veins with proximal origin

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Ayman S Al-Khadra

Abstract

Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy (CRT) devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very proximal origin of the lateral or postero-lateral cardiac vein. We describe an alteration of existing left ventricular (LV) lead delivery sheath with the creation of a side-hole 35-50 mm from its tip. This modification is made to provide access to proximal cardiac vein ostia, while maintaining adequate support for the delivery system. The modified introducer sheath was used in the implantation of six CRT systems (four defibrillators and two pacemakers) in patients who had a proximal origin of the lateral or postero-lateral cardiac vein, all of which were successful and without complications. In those patients with unusual proximal origin of target LV veins, modifications of the introducer sheath with the creation of a side-hole facilitate the successful implantation of the LV pacing lead. Until this modified sheath is tested, this technique is considered experimental and may carry unknown risks.

References

Mar 25, 1999·The American Journal of Cardiology·A AuricchioJ Spinelli
Nov 21, 2000·The American Journal of Cardiology·H PürerfellnerUNKNOWN European EASYTRAK Registry
Dec 19, 2001·Circulation·C ButterUNKNOWN Pacing Therapy for Chronic Heart Failure II Study Group
May 21, 2004·The New England Journal of Medicine·Michael R BristowUNKNOWN Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators
Mar 9, 2005·The New England Journal of Medicine·John G F ClelandUNKNOWN Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators

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