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Updated: Jul 15, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in
Berry M van Gelder1, Mike G Scheffer, Albert Meijer
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. carlgr@cze.nl <carlgr@cze.nl>
Background:
Coronary sinus (CS) lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a failure rate at implant and short-term follow-up between 10% and 15%.
Objective:
The purpose of this study was to assess the feasibility of transseptal endocardial LV pacing in patients in whom transvenous CS lead placement had failed.
Methods:
An atrial transseptal LV lead placement was attempted in 10 patients (six females, age 69.4 +/- 9.6 years), in whom CS lead placement for CRT had failed. After transseptal puncture and septal dilatation from the femoral route, the left atrium was cannulated with a combination of catheters and guide wires from the left or right subclavian vein. After advancement of this guide catheter into the LV, a standard bipolar screw-in lead could be implanted in the posterolateral wall. All patients were maintained on anticoagulant therapy with warfarin after implant.
Results:
An LV lead could be successfully implanted in nine of the 10 patients. The stimulation threshold was 0.78 +/- 0.24 V, and the R-wave amplitude was 14.2 +/- 9.7 mV. At 2 months' follow-up, the stimulation threshold was 1.48 +/- 0.35 V with a 0.064 +/- 0.027 ms pulse width. There was no phrenic nerve stimulation observed in any of the patients. There were no thromboembolic complications at follow-up.
Conclusions:
LV transseptal endocardial lead implantation from the pectoral area is a feasible approach in patients with a failed CS approach and in whom epicardial surgical lead placement is not an option. Longer follow-up is warranted to determine the risk of thromboembolic complications.
