Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure
F. Leclercq et al., Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure, PACE, 22(11), 1999, pp. 1570-1575
Citations number
27
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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.