Percutaneous left ventricular endocardial leads: adverse outcomes and a percutaneous extraction case series

Abstract

Background Conventional cardiac resynchronization therapy (CRT) involves the placement of an epicardial left ventricular (LV) lead through the coronary venous tree. However, alternative approaches of delivering CRT have been sought for patients who fail to respond to conventional methods or for those where coronary venous anatomy is unfavourable. Biventricular pacing through an endocardial LV lead has potential advantages; however, the long-term clinical and safety data are not known. Case summary This article details a case series of four patients with endocardial LV leads; three of these for previously failed conventional CRT and a fourth for an inadvertently placed defibrillator lead. Discussion We describe the clinical course and adverse events associated with left-sided leads and subsequently describe the safe and feasible method of percutaneous extraction.

Lead extraction of an unintentional pacemaker lead implantation in the left ventricle from the left subclavian artery

“…Placement of a pacemaker lead into the left ventricle (LV) can be associated with thromboembolic events (33%–37%), 1,2 mitral or aortic valve damage, 3,4 endocarditis 5 and higher probability of diaphragmatic pacing and elevated thresholds.…”