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Europace Advance Access originally published online on May 9, 2007
Europace 2007 9(7):533; doi:10.1093/europace/eum068
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

BIVENTRICULAR PACING

A grateful heart

Máximo Rivero-Ayerza*, Emile Jessurun, Dominic A.M.J. Theuns and Luc J. Jordaens

Thorax Center, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Manuscript submitted 14 March 2007. Accepted after revision 21 March 2007.

* Corresponding author: Tel: +31 10 463 3991; fax: +31 10 463 4420. E-mail address: m.riveroayerza{at}erasmusmc.nl

Key Words: Cardiac resynchronization therapy, Left ventricular pacing, Heart failure, Coronary sinus

A 72-year-old man presented with advanced symptoms of heart failure due to an idiopathic dilated cardiomyopathy was diagnosed. He presented with sinus rhythm and a left bundle branch block pattern on the electrocardiogram. The echocardiogram showed a severely depressed left ventricular (LV) systolic function with evidence of intra- and inter-ventricular dyssynchrony. Symptoms were considered to be refractory to standard medical therapy and the patient was advised to undergo cardiac resynchronization therapy device implantation. The patient underwent trans-venous implantation of a biventricular defibrillator. A magnetic guidewire was remotely steered to the coronary sinus side branch. Due to marked tortuosity of a lateral side branch (the ideal pacing site), positioning of the LV pacing lead was difficult and time-consuming (Figure 1). Aware of the difficulty and the efforts spent in accessing the ideal LV pacing site, the patient considered the peculiar shape described by the LV lead inside his heart as a way of expressing his gratitude. He presented no complications during the procedure and was dismissed uneventfully 48 h after implantation.


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  		Figure 1 Fluoroscopic view of the final position of the LV pacing lead positioned in a markedly tortuous lateral coronary sinus side branch. Note the peculiar "heart" shape drawn by the lead in a 35° left anterior oblique view.

 


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M. Rivero-Ayerza, E. Jessurun, S. Ramcharitar, Y. van Belle, P. W. Serruys, and L. Jordaens
Magnetically guided left ventricular lead implantation based on a virtual three-dimensional reconstructed image of the coronary sinus
Europace, September 1, 2008; 10(9): 1042 - 1047.
[Abstract] [Full Text] [PDF]

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