Use of a retained guidewire to improve the left ventricular pacing threshold

Although transvenous access to the coronary veins has considerably simplified left ventricular (LV) pacing, it can remain a time consuming and arduous task achieving satisfactory pacing positions for the LV electrode. Common problems include negotiating small veins with adequate guide catheter stability, pacing electrode stability once positioned, and phrenic nerve stimulation. We report a case where use of the pacing lead guidewire resulted in a dramatic reduction in the pacing threshold of the LV lead, and saved the patient the need to undergo thoracotomy placement.