Flexible LV pacing configurations are a useful feature of CRT systems for preventing PNS. The optimal LV pacing configuration should be determined on the basis of individual patient testing.

In patients, incipient deterministic radiation effects can theoretically be observed at dose area product >400 Gy*cm(2), a dose applied in 2.9% of CRT implantation procedures. Special follow-up programs are considered necessary for these patients and for operators, as the latter may be exposed over many years given the unknown long-term impact of chronic radiation exposure and the nature of current complex electrophysiology and device procedures.

We describe the closure of a subclavian artery puncture site with a percutaneous suture device after removal of a pacemaker lead 1 week after its inadvertent positioning in the left ventricle via the subclavian artery. The lead was retracted from the left ventricle into the aorta and linked to a guiding catheter introduced via femoral artery access. The lead and the guiding catheter were removed from the artery to the subclavian area. This manoeuvre allowed the placement of a percutaneous arterial suture device (Perclose) to close the puncture site.

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