Sasaki Shingo, Kaname Noriyoshi, Kinjo Takahiko, Tomita Hirofumi
Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
J Cardiol Cases. 2021 Oct 20;25(4):225-228. doi: 10.1016/j.jccase.2021.09.013. eCollection 2022 Apr.
Complex coronary vein morphology impedes the insertion of the left ventricular (LV) lead and reduces the effectiveness of cardiac resynchronization therapy (CRT). A 77-year-old woman underwent dual-chamber pacemaker implantation via the left subclavian approach for a complete atrioventricular block 17 years previously. She was hospitalized due to decompensated heart failure, and her cardiac rhythm completely depended on ventricular pacing at that time. Transthoracic echocardiography showed thinning of the ventricular septum in the basal region and pacing-induced dyssynchrony. She was clinically diagnosed with cardiac sarcoidosis with severe LV systolic dysfunction. She was referred for an upgrade to CRT. Given that prior contrast venography showed occlusion of the left subclavian vein, an additional LV lead was inserted through the right subclavian vein. Coronary venography showed a lateral vein that branched from the great cardiac vein with an acute angle and had multiple tortuosities in the peripheral branches. Since the LV lead placement was unsuccessful with the conventional method, we attempted the lead placement using the balloon occlusion technique (BOT). Lead delivery into the anatomical optimal lateral vein was successful by using BOT, and LV pacing from the most delayed basal region was achieved in combination with the active fixation LV lead. < The balloon occlusion technique in cardiac resynchronization therapy implantation has been introduced to achieve left ventricular (LV) lead insertion into the coronary vein with a complex morphology. A quadripolar active fixation LV lead, which has been recently developed, has a low dislodgement rate and enables lead placement to the desired location. Application of conventional techniques in combination with the active fixation LV lead is expected to improve the success rate of optimal LV pacing in patients with complex coronary vein morphology.>.
复杂的冠状静脉形态会妨碍左心室（LV）导线的植入，并降低心脏再同步治疗（CRT）的有效性。一名77岁女性17年前因完全性房室传导阻滞经左锁骨下途径植入双腔起搏器。她因失代偿性心力衰竭住院，当时其心律完全依赖心室起搏。经胸超声心动图显示基底部室间隔变薄以及起搏诱导的不同步。她临床诊断为心脏结节病伴严重左心室收缩功能障碍。她被转诊以升级为CRT。鉴于先前的造影剂静脉造影显示左锁骨下静脉闭塞，通过右锁骨下静脉插入了一根额外的左心室导线。冠状静脉造影显示一条从大心脏静脉以锐角分支的外侧静脉，其外周分支有多个弯曲。由于采用传统方法放置左心室导线未成功，我们尝试使用球囊闭塞技术（BOT）进行导线放置。通过使用BOT，成功地将导线送入解剖学上最佳的外侧静脉，并结合主动固定左心室导线实现了从最延迟的基底部区域进行左心室起搏。<心脏再同步治疗植入中的球囊闭塞技术已被引入，以实现将左心室（LV）导线插入形态复杂的冠状静脉。最近开发的四极主动固定左心室导线脱位率低，能够将导线放置到所需位置。预计将传统技术与主动固定左心室导线相结合可提高复杂冠状静脉形态患者实现最佳左心室起搏的成功率。>
