Coronary Sinus Lead Fragmentation 2 Years After Implantation with a Retained Guidewire

Abstract

Cardiac Resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of inter- and intraventricular conduction delays. However implantation of CS leads is somewhat challenging due to a high number of peri- or postoperative dislocations at a rate of about 10%. The retained guidewire technique has been proposed for the implantation of coronary sinus leads for stabilization in case of repetitive intraoperative dislocations. This report describes CS lead and guidewire fracture 2 years after such an implant.

Achieving Permanent Left Ventricular Pacing—Options and Choice

“…The inevitable drawback of these more secure lead fixation measures is that lead extraction becomes much more difficult and may well require cardiac surgery 35,36,39 . Any angioplasty guide wire or stylet permanently retained within the lead lumen may overtime fracture and protrude through the lead body, or interfere with the normal electrical functioning of the lead, posing a potentially serious threat to the patient 45–48 . Because of the shortcomings, these nonstandard lead stabilization techniques should only be used as the last resort and will probably be needed less and less frequently with the development of new lead models.…”

Coronary Sinus Lead Implantation

“…7,9 Transvenous LV lead implantation was new in 1998. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Collaborative development by physicians and industry has resulted in a variety of new tools such as a 9-French (Fr) peel-away sheath, coronary sinus (CS) cannulation assist catheter, vein selectors, and an inner guide capable of delivering up to 7-Fr leads. 10 CRT devices are implanted predominantly by cardiac electrophysiologists employing new skills borrowed from interventional cardiologists and radiologists.…”

Interventional and Minimally Invasive Surgical Techniques Facilitating Cardiac Resynchronization Therapy

“…Stabilizing the lead position with retained stylets is not recommended due to high risk of late lead failure (Nagele, 2007). With active fixation of the CS leads, lead extraction may be an issue if the device has to be explanted.…”