Wire Externalisation for Left Ventricular Lead Placement in Cardiac Resynchronisation Therapy: A Step-by-step Guide

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Left ventricular (LV) lead implantation for cardiac resynchronization therapy (CRT) presents significant challenges.
• Difficulties include tortuous posterolateral (PL) branches, persistent left superior vena cava (SVC), and acute coronary sinus (CS) ostium angles.

Purpose of the Study:

• To describe a wire externalization technique for facilitating challenging LV lead placement.
• To illustrate the technique's utility with case examples.

Main Methods:

• A wire externalization technique is detailed, providing guidewire support for LV lead advancement.
• Both antegrade and retrograde LV lead delivery methods are discussed.
• Potential need for adjunctive balloon angioplasty is noted.

Main Results:

• The wire externalization technique successfully addressed challenges like PL branch tortuosity, persistent left SVC, and acute CS ostium angulation.
• Lead delivery was achieved via antegrade or retrograde approaches, sometimes requiring balloon angioplasty.
• No complications were reported during implantation or at 30-day follow-up.

Conclusions:

• The wire externalization technique is effective in facilitating optimal LV lead placement.
• This method is particularly beneficial for complex CRT cases requiring challenging lead implantation.