surgery report

Had surgery early July ICD/CRT-D and all seems well. I have one question if anyone could answer. From my surgery report seems the first two leads implanted properly but this was the explanation for the third lead. The conclusion described as successful but wondered a little what this means.

The third pacing lead advanced into the CS through the atteans sheath into aposterolateral position having a good pacing threshold very limited anatomy midposterior branch to narrow pass a wire but no the lead at the last position posterolateral branch very narrow as well able to advance only the distal electrode into the branch.

 

2 Comments

midposterior branch

by AgentX86 - 2021-09-06 22:21:23

Pacemaker leads can only go into the right side of the heart.  The vein (artery, really) into the left side of the heart comes from the lungs, so there is no way to get there from here.  The lead doesn't actually sit in the left ventricle. To pace on the left side, the lead is threaded into one of the coronary arteries (that supply blood to the heart muscle), around to the back of the left ventricle.   It paces from there.

In your case, it seems the artery was too small to get the catheter sheath as far as they wanted but it appears to be working well anyway. 

That's my read, anyway.  Don't worry.  It's working fine.

 

Sorry to disagree

by crustyg - 2021-09-07 03:27:00

Standard pacing wires (RA, RV) enter the heart through the SVC having normally been placed into the venous system from the subclavian vein.

The challenge for CRT is to find a way to get a pacing wire to reach the Left ventricle without resorting to opening the chest or puncturing the perdicardium (tough sac that encloses the heart).  The usual method is to pass a pacing wire into the Coronary Sinus (CS in the notes) - where the venous blood flow leaving the heart muscle enters the RA just above the tricuspid valve.  Getting a sheath and wire into the CS can be very difficult (it's not an easy corner to navigate and it's easy to damage if too much pushing is used).  Once the sheath (provides assistance for the sharp corner for the pacing wire, removed once the wire is in place) is located correctly they like to get the LV pacing wire well along towards the posterior cardiac vein but this wasn't possible due to your anatomy.  However they seemed happy with the pacing wire's ability to stimulate the LV, and with luck it will stay there *and* improve your %LVEF, which is the objective.

Hope that helps.

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