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HeartRhythm Case Reports

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1 HeartRhythm Case Reports
A right subclavian vein approach for interventricular septum puncture and left ventricular endocardial lead placement in cardiac resynchronization therapy  Rogelio Robledo-Nolasco, MD, Gerardo De León-Larios, MD, Oziel Gutierrez-Villegas, MD, Elias Zavaleta-Muñiz, MD, David Eduardo Bazzini Carranza, MD, Omar Calixto-Vargas, MD  HeartRhythm Case Reports  DOI: /j.hrcr Copyright © 2019 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Anteroposterior fluoroscopic view showing left subclavian vein occlusion. B, C: Agilis sheath (St. Jude Medical, St. Paul, MN) placement at mid ventricular septum using left anterior oblique (LAO) and right anterior oblique (RAO) view. D: Confirmation of adequate sheath placement with intracardiac echocardiography. E: Coronariography showing no septal arteries close to ventricular septum puncture site. AL = atrial lead; LV = left ventricle; RV = right ventricle; RVL = right ventricular lead. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Successful ventricular transseptal puncture in left anterior oblique (LAO) view. B: Coronary sinus lead ventricular system is deployed over the guidewire and positioned at left ventricle (LV) lateral wall in LAO view. C: Confirmation of adequate positioning with intracardiac echocardiography. D: Implantation of endocardial lead at LV lateral wall with LAO view. E: Final LV lead position with anteroposterior (AP) view. F: Intracardiac echocardiography view showing adequate positioning of LV lead at LV lateral wall. AL = atrial lead; RVL = right ventricular lead. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

4 Figure 3 Electrocardiogram comparison of right ventricle (RV) pacing prior to the procedure and biventricular (BV) pacing after successful left ventricular lead implantation. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © 2019 Heart Rhythm Society Terms and Conditions

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