Cardiac resynchronization therapy from an iliac approach in a patient without superior access: a case report
Lei Xu1,2, Yangang Su1,2, Shengmei Qin1,2
1Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 China.
Insights
Iliac vein access offers a viable alternative for cardiac resynchronization therapy (CRT) implantation when superior venous access is not possible. This approach ensures stable lead placement and improved cardiac function in patients with heart failure and left bundle branch block (LBBB).
Area of Science:
- Cardiology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) is beneficial for heart failure patients with left bundle branch block (LBBB).
- Superior venous access for CRT implantation can be challenging or unfeasible in some patients.
Observation:
- A 50-year-old male with dilated cardiomyopathy and LBBB presented with occluded brachiocephalic veins.
- CRT was successfully implanted using an alternative iliac vein access route.
Findings:
- Iliac vein access provided stable lead placement for CRT.
- Post-implantation echocardiography demonstrated improved cardiac function.
Implications:
- Iliac vein access is a feasible alternative for CRT implantation when standard venous access fails.
- This method avoids risks associated with thoracotomy and epicardial lead placement.
Background:
Cardiac resynchronization therapy (CRT) has been shown to benefit patients with heart failure and left bundle branch block (LBBB). However, CRT implantation is challenging when the superior venous access is not feasible.
Case Summary:
A 50-year-old man with a history of dilated cardiomyopathy and complete LBBB was referred to our hospital for CRT management. Angiography showed that the left and right brachiocephalic veins were occluded. Cardiac resynchronization therapy was finally implanted via the iliac vein. Follow-up echocardiography showed improved cardiac function, and the pacing system was functioning properly.
Discussion:
The iliac vein access is feasible for CRT implantation with good stability, which can be a viable alternative to avoid unnecessary risk associated with thoracotomy and epicardial lead placement.
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