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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Collateral approach for biventricular pacing of coronary sinus ostium obstruction

Yoshimitsu Soga1, Kenji Ando, Masakiyo Nobuyoshi

  • 1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

Pacing and Clinical Electrophysiology : PACE
|January 10, 2008
PubMed

Insights

A novel approach successfully implanted a left ventricular lead via a collateral pathway in a patient with complete atrioventricular block and dilated cardiomyopathy, improving heart failure symptoms. The long-term safety of this technique requires further investigation.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Interventional Cardiology

Background:

  • Dilated cardiomyopathy and complete atrioventricular block often lead to chronic heart failure.
  • Cardiac resynchronization therapy (CRT) is a treatment option for heart failure unresponsive to conventional medical management.
  • Standard CRT lead implantation involves the coronary sinus, which can be challenging in certain anatomies.

Observation:

  • A 71-year-old male patient with dilated cardiomyopathy and complete atrioventricular block presented with refractory chronic heart failure.
  • Coronary venography revealed complete obstruction of the coronary vein ostium.
  • Contrast medium demonstrated an alternative collateral pathway originating from the right atrium.

Findings:

  • A left ventricular lead was successfully implanted utilizing the identified collateral pathway.
  • The implantation procedure was completed without any immediate complications.
  • Postoperative measurements showed a threshold of 2.7 V at 0.4 ms.
  • The patient experienced subjective improvement in heart failure symptoms following CRT.

Implications:

  • This case demonstrates a potential alternative strategy for left ventricular lead placement in patients with challenging coronary venous anatomy.
  • Successful lead implantation via collateral pathways may expand CRT eligibility.
  • Further studies are needed to establish the long-term safety and efficacy of this unconventional approach.

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