A METHOD FOR PERMANENT TRANSVENOUS LEFT-VENTRICULAR PACING

LV-based pacing has recently been reported to be of benefit in patient s with severe cardiac failure and left bundle branch block. LV permane nt pacing has been reported using epicardial leads but the surgical mo rtality is excessive. A transvenous approach is now favored. in this r egard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challe nging. We describe a ''long guiding sheath'' method using catheterizat ion, and a long radiopaque and peelable sheath. Once the coronary sinu s is cannulated with the electrophysiological catheter, the long sheat h is advanced to the mid-part of the coronary sinus. The permanent pac ing electrode is then placed through the sheath and into a tributary o f the coronary sinus. This method has been attempted in 10 patients an d 10 as successful in 8, with an average lead insertion time of 21 +/- 5.5 minutes and an average fluoroscopic time of 11 +/- 5.5 minutes. I n conclusion, although transvenous left ventricular pacing remains a c hallenge, the ''long guiding sheath'' approach appears to facilitate t his procedure with both a high success rate and an acceptable procedur e time.