Initial Japanese experience and long-term follow-up with a new active fixation coronary sinus lead, the StarFix 4195

Technologies associated with cardiac resynchronization therapy (CRT) devices and lead systems have progressed. However, dislocation after coronary sinus (CS) lead placement continues to be a problem. Furthermore, CS lead positioning at the site of the ventricular latest activation (detected by echocardiography) is often problematic due to large vessel size leading to the lead placement (wedge site) near the apical site. The newly available active fixation CS lead (StarFix 4195) enabled us to anchor the CS lead at the target site regardless of vessel size and availability of a wedge site. We report on seven patients who had previously failed conventional CS lead positioning due to large vessel size and a low phrenic nerve stimulation threshold at the optimal site and lack of stabilization followed by dislocation at the target vein. We attempted to replace the original lead with the StarFix 4195. All patients successfully underwent StarFix 4195 lead replacement at the target site and responded to CRT in the long-term follow-up period.