Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy

Abstract

The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.

Antidromic snare technique for re-implantation of a coronary sinus lead into the same cardiac vein after transvenous lead extraction: a case report

“…However, Kim et al reported that vessel perforation, pericardial effusion, cardiac tamponade, and lead damage did not occur when the snare technique was used. 6 When the snare technique cannot be performed due to a lack of connecting vessels, epicardial lead implantation, or conduction system pacing could be alternative options. 11 , 12 …”

“… 4 , 5 The anti-dromic snare technique for CS lead implantation was reportedly very useful when the target vessel was dissected, stenotic, or tortuous. 6 , 7 Herein we present a case of re-implantation of a CS lead using the anti-dromic snare technique into the occluded vessel after CS lead extraction.…”

Special Issue: Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy and Conduction System Pacing

“…More simple to use would be QRS narrowing by CRT [37]; however, super-response can occur in the absence of a significant reduction in QRS duration. Reaching an optimal lead position can be difficult, but improved technologies such as snare techniques have increased the number of target veins within the coronary sinus [38].…”