A method for permanent transvenous left ventricular pacing

Jean Jacques Blanc, David G. Benditt, Martine Gilard, Yves Etienne, Jacques Mansourati, Keith G. Lurie

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

LV-based pacing has recently been reported to be of benefit in patients with severe cardiac failure and left bundle branch block. LV permanent pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a "long guiding sheath" method using catheterization, and a long radiopaque and peelable sheath. Once the coronary sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 ± 5.5 minutes and an average fluoroscopic time of 11 ± 5.5 minutes. In conclusion, although transvenous left ventricular pacing remains a challenge, the "long guiding sheath" approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.

Original languageEnglish (US)
Pages (from-to)2021-2024
Number of pages4
JournalPACE - Pacing and Clinical Electrophysiology
Volume21
Issue number11 I
DOIs
StatePublished - Nov 1998

Keywords

  • Heart failure
  • Left ventricular pacing
  • Transvenous pacing

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