Postmortem anatomy of the coronary sinus pacing lead

Biventricular pacing nowadays represents a recognized method of nonpharmacological treatment of severe congestive heart failure refractory to medication. A growing number of biventricular implants is likely to bring an increasing demand for the extraction of specially designed coronary sinus (CS) leads for left ventricular pacing. There is a lot of data regarding conventional pacing or defibrillation lead extractions, but only very limited experience with the CS lead extractions. We describe the pathological-anatomical findings of a woman who died after 26 months postimplantation due to refractory ventricular fibrillation with focus on the left ventricular pacing lead course and feasibility of extraction.