Temporary pacing wire in the coronary sinus: a novel treatment of acute heart failure?

Abstract

Treatment of acute heart failure relies initially on medical therapy. Patients can be considered for cardiac resynchronization therapy once they are able to lie flat for several hours. However, placement of a temporary pacing wire (TPW) into the coronary sinus may allow the patient to receive resynchronization therapy in the acute phase. We report a case of a patient who had a dramatic improvement of symptoms and blood pressure after a TPW was placed in the coronary sinus.

Temporary transvenous pacing guided by the combined use of ultrasound and intracavitary electrocardiography: a feasible and safe technique

“…Misplacement into the pulmonary artery and IVC can also be readily detected by TTE [4, 8], allowing the redirection of the EC to an optimal position. The insertion in the coronary sinus (CS) [17] is another rare possibility, especially occurring when the CS is dilated or when a left-sided insertion (left IJV or subclavian vein) is attempted, and a persistent left superior vena cava is present. CS can be well-visualized in a foreshortened apical four-chamber view (Fig.…”

“…Thus, there are lower risks of cardiac failure after TVP. In the absence of other complications or TVP malfunctioning, a CS lead can be safely kept in place [17]. The same principle of more physiologic ventricular depolarization applies also to RV leads that are not located in the ventricular apex, with lesser degrees of asynchrony in leads placed in the interventricular septum in comparison with apical leads.…”