Placing third lead to LV

Hi everyone, I will be scheduled for surgery soon to replace my dual chamber pacer(4th one) with a biventricular pacer (CRT-P). My surgeon says it can be done as long as the coronary sinus vein can accommodate the wire. I'm 91 years old and I think this surgery will give me better quality of life, Doctor will do venogram prior to surgery( venogram/contrast) to see if that vein will be adequate size for lead. I'm just curious, how common is that problem an issue? I hope it's not often ands only a small percentage

Thanks

2 Comments

Not common, but common enough to be a nuisance

by crustyg - 2021-11-03 13:52:00

The challenge is both the small size of the opening of the coronary sinus and the angle needed to thread the pacing lead into the sinus without damaging the wall.

I don't have proper figures - it's not an area I specialised in, and I've never asked my EP-doc about it, but it can sometimes be a problem.  As with all of these procedures, a lot depends on the skill of the operator...

However, if getting an LV-pacing lead into the coronary sinus can't be done, it's not a complete blocker to getting you a third lead placed for CRT to have a chance.  It's possible to place a lead to the *outside* of the LV (these days done using an endoscopic approach, so no cracking the chest open) and then tunnel the lead up to the pocket where the PM/CRT sits.

Best wishes.

Thank you

by Rxrich - 2021-11-03 17:46:00

for the info on the different procedures. They will be replacing my 4th dual chamber PM and replacing it with a biventricular PM. I don't have a surgery date yet but it will be done sometime this month. I don't know if endoscopic will work for me. I notice the pacer is placed in a lower part of the body. Will stop worrying about it and wait for more info frm ep. Thank you so much for your input

R

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