Related Experiment Video
Updated: Jun 2, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transseptal left ventricular endocardial pacing: preliminary experience from a femoral approach with subclavian
Berry M van Gelder1, Patrick Houthuizen, Frank A Bracke
1Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. carlgr@cze.nl
Insights
This study presents a novel femoral transseptal approach for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) when traditional methods fail. The technique proved feasible and safe, offering an alternative for challenging cases.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Coronary sinus (CS) lead placement for cardiac resynchronization therapy (CRT) has limitations.
- Transseptal left ventricular (LV) endocardial implantation via a superior approach is not always successful.
Purpose of the Study:
- To assess the feasibility of a femoral transseptal endocardial LV approach for pacing.
- To evaluate this technique in patients with prior failed CS or superior transseptal LV lead implantation.
Main Methods:
- A 4.1 French active fixation lead was implanted endocardially in the LV using a femoral approach.
- An 8F transseptal sheath and a hooked 6F catheter were utilized.
- The lead was subsequently pulled through to the pectoral device location.
Main Results:
- Successful LV endocardial implantation was achieved in all 11 patients.
- Stimulation threshold, lead impedance, and R wave amplitude were within acceptable ranges.
- Stable lead parameters and no dislodgements or thrombo-embolic events were observed during follow-up (1-6 months).
Conclusions:
- The femoral transseptal technique is a viable alternative for LV endocardial lead implantation.
- This method is effective for patients with failed CS or superior transseptal attempts.
- It is also suitable for pacing sites more accessible via a femoral approach.
Aims:
Coronary sinus (CS) lead placement for transvenous cardiac resynchronization therapy (CRT) even combined with transseptal left ventricular (LV) endocardial implantation from a superior approach still does not have 100% success rate. The aim of this study was to assess the feasibility of a femoral transseptal endocardial LV approach pacing in patients in whom a transvenous CS or a transseptal LV endocardial implantation with a superior approach had failed. We report our first experience with LV endocardial lead placement for CRT with a femoral transseptal technique followed by intravascular pull-through to the pectoral location.
Methods And Results:
In 11 patients, 10 males (61.5 ± 9.5 years) with failed CS implant (four patients) or repeated CS lead malfunction (seven patients), a 4.1 French active fixation lead was implanted endocardially in the left ventricle employing a femoral approach using an 8F transseptal sheath combined with a hooked 6F catheter. After successful implantation, the lead was pulled through from the femoral insertion site to the pectoral device location. The LV endocardial implantation was successfully performed in all patients. Stimulation threshold was 0.62 ± 0.33 V, lead impedance 825 ± 127 Ω, and R wave 12.8 ± 8.3 mV. Threshold and lead impedance were stable during follow-up, which varied from 1 to 6 months. No dislodgements were observed and there were no thrombo-embolic events during follow-up.
Conclusion:
This technique for LV endocardial lead implantation is an alternative for failed CS and superior transseptal attempts using standard techniques and equipment. It is also applicable for pacing sites that are more easily reached from a femoral approach.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Cardiac Catheterization II: Right Heart Catheterization