Coronary vein angioplasty to facilitate implantation of left ventricular lead

Stenosis in the coronary veins can cause the failure of left ventricular (LV) lead implantation, which is the cornerstone of cardiac resynchronization therapy (CRT). There are several cases in which LV pacing could be possible after successful elimination of coronary vein stenosis by coronary vein angioplasty. The study was conducted to investigate the efficacy of coronary vein angioplasty with an aim to a facilitate implantation of LV lead.

Transvenous LV leads were implanted in 118 consecutive patients from November 2001 to January 2009. Retrospective analysis performed by the CRT system showed that 3 of 118 patients (2.54%) needed coronary vein angioplasty to facilitate the lead placement. Each target vein was successfully dilated by using coronary balloon angioplasty catheters of 2.5 mm (2 patients) and 3.0 mm (1 patient). Then the LV leads could be inserted and there were no complications.

Coronary vein angioplasty is an effective and safe technique to make transvenous LV pacing lead insertion a possibility in case of target vein stenoses.