Kind of a summary of my recent Cath Lab event with my EP and his assistants;
Indications: Left ventricular dyssynchrony
Conclusion: Unsuccessful attempt of LV lead implant or His bundle pacing from the right subclavian vein. Consider epicardial LV lead placement.
Procedure: "Attempt LV lead implant. Patient was taken to the EP lab. Venogram was performed which demonstrated patent right subclavian vein. Patient was prepped and draped in sterile fashion. Vancomycin was given for indication of pacemaker lead implant. Local anesthetic was administered to the right shoulder. Incision was made inferior clavicle. A subcutaneous pocket was created with bovie. It was then irrigated with antibiotic solution and inspected for hemostasis. Using modified Seldinger technique, subclavian vein was accessed. Quadrapolar catheter was advanced into the right atrium through a CS sheath. Coronary sinus was accessed with difficulty due to right side approach. CS sheath was advanced into the coronary sinus and the catheter was withdrawn. CS sheath was advanced with difficulty due to orientation of the sheath against the wall of the middle coronary sinus. Sheath was flushed. Venogram was performed. Which showed no lateral branch in the coronary sinus. There was an inferiorly directed middle cardiac vein at the ostium. Despite multiple attempt the middle cardiac vein cannot be engaged due to its inferior direction. CS sheath was removed. A His bundle pacemaker lead delivery sheath was introduced. Due to patient's complete heart block, His bundle pacemaker lead implant was performed empirically and anatomically at several area. Each site demonstrated only RV septum capture without His capture. At this stage, the procedure was aborted due to failure of both LV and His bundle pacemaker lead implant. Total fluoroscopic time 30 minutes."
Anyone able to give me info to increase my undertanding of the above? I meet with the EP in 10 days, and I'd like to be better prepared.