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Yoked Catheter Positioning in Transseptal Endocardial Left Ventricular Lead Placement.
MedLine Citation:
PMID:  21418248     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Transseptal (TS) endocardial left ventricular (LV) lead placement may be needed for cardiac resynchronization therapy, and often requires crossing a preformed puncture in the interatrial septum (IAS) with a lead delivery catheter inserted from an upper body vein (UBV), which can be difficult or impossible to achieve by manipulation from its hub. Consequently, yoked superior approach TS catheterization was developed. Methods: A loop snare housed in a deflectable delivery catheter inserted from an UBV captured the guide wire extending out of a TS sheath inserted from the right femoral vein into the inferior vena cava (IVC). After the IAS had been punctured, the guide wire was left in the left atrium (LA) and the TS sheath withdrawn into the IVC. The delivery catheter was advanced over the snare onto the guide wire, and then pushed by the TS sheath across the IAS puncture into the LA. The snare released the guide wire and was withdrawn. The delivery catheter was manipulated to point toward the LV for lead deployment. If that was not possible, the IAS puncture was dilated with an electrophysiology (EP) catheter housed in a second TS sheath alongside the first one. The EP catheter was captured by the snare and manipulated across the IAS puncture into the LV. The delivery catheter was advanced over the EP catheter directly into the LV. Results: The technique was tried in four patients with challenging anatomy and allowed successful endocardial LV lead placement in all. Conclusions: Yoked catheter positioning facilitates TS endocardial LV lead placement. (PACE 2011; 1-10).
Authors:
Ernest W Lau
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-21
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2011, The Author Journal compilation ©2011 Wiley Periodicals, Inc.
Affiliation:
Department of Cardiology, Royal Victoria Hospital, Belfast, UK.
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