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Published on: February 18, 2020
[Coronary venoplasty during the implantation of the cardiac resynchronisation device--a case report]
Andrzej Przybylski1, Krzysztof Cedro, Tomasz Szajewski
1Klinika Zaburzeń Rytmu Serca, Instytut Kardiologii, ul. Alpejska 42, 04-628 Warszawa. aprzybylski@ikard.pl
Insights
A challenging cardiac resynchronisation therapy (CRT) case involved a patient with His-Purkinje system block. Successful biventricular pacing was achieved after balloon venoplasty for difficult coronary venous anatomy.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- A 76-year-old patient presented with advanced His-Purkinje system block, necessitating cardioverter-defibrillator implantation with cardiac resynchronisation therapy (CRT).
Observation:
- Complete heart block complicated the initial coronary sinus catheterization.
- Difficult coronary venous anatomy precluded immediate left ventricular (LV) lead placement.
- Right ventricular pacing worsened QRS duration and heart failure symptoms.
Findings:
- Successful LV lead implantation was achieved in a second procedure following balloon venoplasty of a lateral cardiac vein.
- Biventricular pacing was successfully established.
Implications:
- This case highlights the utility of interventional techniques like balloon venoplasty in overcoming anatomical challenges during CRT lead implantation.
- Successful CRT in complex cases can improve heart failure management and patient outcomes.
Abstract:
We describe a case of a 76-year-old patient with advanced block in the His-Purkjnie system, who underwent implantation of a cardioverter-defibrillator with cardiac resynchronisation therapy. Complete heart block occurred during the insertion of the coronary sinus cathether. The implantation of the left ventricular (LV) lead was impossible due to difficult anatomy of the coronary venous system. The right ventricular pacing caused the further prolongation of the QRS duration and exacerbation of heart failure symptoms. Thus, the LV lead was successfully implanted during the second procedure after the balloon venoplasty of the lateral cardiac vein. The biventricular pacing was successful during 4 months follow-up.
