Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead

Abstract

Cardiac resynchronization therapy via the coronary sinus (CS) is not always possible. Left ventricular (LV) endocardial lead placement is a potential alternative. The purpose of this study was to assess the feasibility of endocardial LV pacing using a steerable lead introducer and active fixation polyurethane lead. Endocardial LV lead placement was attempted in nine patients (seven males, age 48–77 years) in whom transvenous CS lead placement had failed. Trans-septal puncture and septal dilatation were performed via the femoral route. A steerable introducer catheter was advanced across the septal puncture site from the right or left subclavian vein into the LV. An active fixation polyurethane lead was then implanted into the high postero-lateral aspect of the LV endocardial wall. All patients were anticoagulated following implant. Successful LV lead placement was achieved in eight patients. There were no acute complications and no embolic events during follow-up (1–32 months). All implanted patients responded well with either improvement in New York Heart Association class or maintenance of symptomatic improvement that had previously been conferred by LV epicardial pacing. Targeted LV endocardial pacing is a potential alternative to CS pacing and warrants a trial to characterize long-term benefits and risks.