Stabilization of the coronary sinus lead position with permanent stylet to prevent and treat dislocation

Coronary sinus (CS) leads used for cardiac resynchronization have undergone development in the last years. However, dislocation rate remained high. We explain a simple method to stabilize the CS lead position.

Thirty-five patients (11 females, aged 60 +/- 9.2 years) were treated with this method. An over-the-wire left ventricular (LV) pacing lead system was introduced and lodged in the vessel. Then, a stiff stylet was inserted and kept into the CS lead and end of the stylet was cut by a scissor (permanent stylet technique). Pacing and sensing properties of all leads were checked and the guiding sheath was removed. Control echocardiography did not show pericardial effusion. The mean LVpacing threshold was 1.2 +/- 0.8 V and the mean impedance was 625 +/- 143 Omega at the implantation. During follow-up (12.5 +/- 2.5 months), there were no statistically significant changes in pacing threshold and impedance when compared with the implantation measurements. At the last patient visit, the mean LV pacing threshold was 1.1 +/- 0.8 V and the mean impedance was 620 +/- 140 Omega. Impedance measurements did not suggest lead insulation failure. No LV lead dislocations were detected in our 35 cases during the follow-up.

Permanent stylet technique seems to be a safe and effective procedure to stabilize CS lead position as demonstrated by our 1-year long follow-up results.