キンジヨウ　タカヒコ   Kinjiyou Takahiko   金城　貴彦    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	The usefulness of balloon occlusive left ventricular lead delivery in combination with the quadripolar active fixation lead for a patient with complex coronary venous morphology.
掲載誌名	正式名：Journal of cardiology cases 略　 称：J Cardiol Cases ISSNコード：18785409/18785409
掲載区分	国内
巻・号・頁	25(4),pp.225-228
著者・共著者	Sasaki Shingo† *, Kaname Noriyoshi, Kinjo Takahiko, Tomita Hirofumi
発行年月	2022/04
概要	Complex coronary vein morphology impedes the insertion of the left ventricular (LV) lead and reduces the effectiveness of cardiac resynchronization therapy (CRT). A 77-year-old woman underwent dual-chamber pacemaker implantation via the left subclavian approach for a complete atrioventricular block 17 years previously. She was hospitalized due to decompensated heart failure, and her cardiac rhythm completely depended on ventricular pacing at that time. Transthoracic echocardiography showed thinning of the ventricular septum in the basal region and pacing-induced dyssynchrony. She was clinically diagnosed with cardiac sarcoidosis with severe LV systolic dysfunction. She was referred for an upgrade to CRT. Given that prior contrast venography showed occlusion of the left subclavian vein, an additional LV lead was inserted through the right subclavian vein. Coronary venography showed a lateral vein that branched from the great cardiac vein with an acute angle and had multiple tortuosities in the peripheral branches. Since the LV lead placement was unsuccessful with the conventional method, we attempted the lead placement using the balloon occlusion technique (BOT). Lead delivery into the anatomical optimal lateral vein was successful by using BOT, and LV pacing from the most delayed basal region was achieved in combination with the active fixation LV lead. <Learning objective: The balloon occlusion technique in cardiac resynchronization therapy implantation has been introduced to achieve left ventricular (LV) lead insertion into the coronary vein with a complex morphology. A quadripolar active fixation LV lead, which has been recently developed, has a low dislodgement rate and enables lead placement to the desired location. Application of conventional techniques in combination with the active fixation LV lead is expected to improve the success rate of optimal LV pacing in patients with complex coronary vein morphology.>.
DOI	10.1016/j.jccase.2021.09.013
PMID	35911072