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Challenging Implants Require Tools and Techniques Not Tips and Tricks.

Seth J Worley1

  • 1Cardiac Electrophysiology Division, Medstar Heart and Vascular Institute, 110 Irving Street Northwest, Suite 5A-12, Washington, DC 20010, USA.

Cardiac Electrophysiology Clinics
|February 6, 2019
PubMed
Summary
This summary is machine-generated.

The interventional telescoping technique offers solutions for challenging cardiac resynchronization therapy (CRT) device implantations. This method aids in difficult coronary sinus (CS) access and lead placement in complex venous anatomies.

Keywords:
Amplatz support wire techniqueAmplatz wireAnchor balloonAntidromic snare techniqueCS atresiaCS cannulationOrthodromic snare techniqueVein selectors

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Cardiac resynchronization therapy (CRT) device implantation requires precise lead placement in the coronary sinus (CS) and its branches.
  • Standard techniques may fail in patients with complex venous anatomy or access difficulties.
  • The coronary sinus (CS) can be challenging to cannulate or navigate due to various anatomical factors.

Purpose of the Study:

  • To describe the interventional telescoping technique for CRT device implantation.
  • To highlight specific clinical scenarios where this technique is particularly beneficial.
  • To provide guidance for electrophysiologists facing challenging coronary sinus access.

Main Methods:

  • The article details the "interventional telescoping technique" for CRT device implantation.
  • Focus is placed on overcoming difficulties in accessing and navigating the coronary sinus (CS) and target veins.
  • The technique involves specific tools and procedural steps to manage challenging anatomies.

Main Results:

  • The interventional telescoping technique is invaluable in cases of CS localization failure.
  • It addresses challenges such as inability to advance catheters/wires, CS atresia, and unstable CS access.
  • The technique is effective for navigating angulated, small, tortuous, or uniquely positioned target veins.

Conclusions:

  • The interventional telescoping technique provides a viable solution for complex CRT implantations.
  • It expands the feasibility of CRT in patients with difficult coronary sinus anatomy.
  • This approach enhances the success rate of lead placement in challenging cases.