Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure

This article describes a new technique of LV lead insertion, using transsep tal catheterization performed through the right internal jugular vein, to o btain a totally endocardial biventricular chronic pacing in end-stage heart failure. Three patients with QRS widening (> 180 ms) linked to complete le ft bundle branch block (n = 2) or right ventricular pacing (n = 2) were inc luded in this preliminary study. Catheterization n as performed under fluor oscopy and transesophageal echocardiography guidance. Transseptal catheteri zation was achieved by puncture of the right internal jugular vein at the b ase of the neck and by using a Brockenbrough needle, the tip curve of which was more curved than the standard model. A flexible long sheath was advanc ed in the left atrium through the interatrial septum and then a unipolar el ectrode was placed easily in the LV. The proximal tip of the LV lead was tu nneled from the neck to the subclavian area and connected to the ventricula r channel of a dual (n = 2) or simple (n = 2) chamber pacemaker. Efficient acute sensing (V wave amplitude = 13 +/- 3 mV) and pacing (acute pacing thr eshold = 0.7 +/- 0.4 V) were obtained in the three patients. Early loss of capture occurred in two patients requiring lead replacement. Functional sta tus dramatically improved in all three pa tien ts. At 6-month follow-up , b iventricular pacing was maintained in all patients (mean threshold 1.4 V) w ho were free of clinical embolic event with oral anticoagulation therapy. T his modified technique of jugular transseptal catheterization appears promi sing for the development of left heart pacing.