Transvenous permanent pacing lead placement in the presence of prosthetic metallic tricuspid and mitral valves

We report a case of a patient with an additional great cardiac vein, discovered during the implantation for cardiac resynchronization therapy (CRT). Anomalies of the coronary sinus and its tributaries may cause difficulties in appropriate implantation of the left ventricular lead but they can also be considered as alternatives for lead placement. Although unusual angiogram of the coronary venous system, a left ventricular pacing lead was successfully placed in the left marginal vein. To settle diagnostic doubts, multislice computed tomography was carried out.

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The Atrioventricular Conduction Axis and its Implications for Permanent Pacing

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2021.32 ◽

2021 ◽

Vol 10 (3) ◽

pp. 181-189

Author(s):

José-Ángel Cabrera ◽

Robert H Anderson ◽

Andreu Porta-Sánchez ◽

Yolanda Macías ◽

Óscar Cano ◽

...

Keyword(s):

Aortic Root ◽

Individual Variability ◽

Atrioventricular Conduction ◽

Extensive Review ◽

Anatomical Features ◽

Stable Position ◽

His Bundle ◽

Permanent Pacing ◽

Pacing Lead

Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead.

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Computational Simulation of Biventricular Pacing in an Asymptomatic Human Heart

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53110 ◽

2011 ◽

Author(s):

Corey L. Murphey ◽

Jonathan Wong ◽

Ellen Kuhl

Keyword(s):

Biventricular Pacing ◽

Computational Simulation ◽

Systolic Heart Failure ◽

Cardiac Resynchronization ◽

Conduction Delay ◽

Intraventricular Conduction ◽

Lead Placement ◽

Pacemaker Leads ◽

Pacing Lead ◽

The Right

Cardiac resynchronization therapy (CRT) through biventricular stimulation was first used in the early 1990s as a treatment option for patients with systolic heart failure, intraventricular conduction delay, and other cardiac arrhythmias [1]. CRT, also known as biventricular pacing (BiVP), is an alternative to right ventricular stimulation, which induces dyssynchronous ventricular contraction. In BiVP, three pacing leads are usually placed on the myocardium of the right atrium, the right ventricle, and the left ventricle in the distal cardiac vein. Because there are no standardized loci for lead placement in BiVP, physicians rely on trial and error when inserting pacemaker leads and use electrocardiograms (ECG) to determine the effectiveness of the BiVP lead placement. The ECG measures the electrical conduction, contraction pacing, and projections of the anatomy of the myocardium. Abnormalities in the sinusoidal waves of the ECG reveal problems. Therefore, the ECG can depict a quantitative representation of the effectiveness of biventricular pacing lead placement.

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