Transseptal left ventricular lead placement using snare technique

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Coronary sinus (CS) lead placement for cardiac resynchronization therapy (CRT) has a notable failure rate of 5-10%.
• Alternative methods are needed for successful left ventricular (LV) lead implantation.

Purpose of the Study:

• To describe a novel technique for endocardial LV lead implantation using transseptal puncture (TSP).
• To evaluate the feasibility and success of this method in patients with previous failed CS lead placements.

Main Methods:

• Transseptal puncture (TSP) was performed via the femoral vein in three male patients (67-83 years) with prior failed epicardial LV leads.
• An active fixation pacing lead was advanced from the subclavian vein, and a GooseNeck snare was used via the TSP sheath to capture the lead tip.
• The system was advanced across the interatrial septum into the left atrium for LV lead implantation.

Main Results:

• Successful endocardial LV lead implantation was achieved in all three patients.
• Implantation times ranged from 25 to 55 minutes.

Conclusions:

• Transseptal puncture with a GooseNeck snare and deflectable sheath is a reliable alternative for endocardial LV lead placement.
• This technique is particularly useful in patients experiencing failure with traditional coronary sinus lead implantation.