Toru Kawakami

Safety and Effectiveness of Placement of Pacemaker Leads for Cardiac Resynchronization Therapy in the Axillary Vein by Double Target-guided Venipuncture

Background: The increasing incidence of damage to pacemaker leads for cardiac resynchronization therapy (CRT. is an emerging problem that should be prevented. The extrathoracic venipuncture approach has been suggested as a technique for venous access to avoid the problem. Methods and Results: 10 patients had pacemaker lead placement for CRT using the double target method. The lead was inserted in the extrathoracic portion of the subclavian and/or axillary veins without complications in all of the patients. Conclusion: This approach achieves accurate, safe, and speedy extrathoracic venipuncture and is especially suitable for multiple lead placements for CRT.

Stent placement to stabilize the left ventricular lead in the coronary sinus

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug‐resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III‐IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re‐operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course.