Placing third lead to LV

Hi everyone, I will be scheduled for surgery soon to replace my dual chamber pacer(4th one) with a biventricular pacer (CRT-P). My surgeon says it can be done as long as the coronary sinus vein can accommodate the wire. I'm 91 years old and I think this surgery will give me better quality of life, Doctor will do venogram prior to surgery( venogram/contrast) to see if that vein will be adequate size for lead. I'm just curious, how common is that problem an issue? I hope it's not often ands only a small percentage

Thanks

2 Comments

Not common, but common enough to be a nuisance

by crustyg - 2021-11-03 13:52:00

The challenge is both the small size of the opening of the coronary sinus and the angle needed to thread the pacing lead into the sinus without damaging the wall.

I don't have proper figures - it's not an area I specialised in, and I've never asked my EP-doc about it, but it can sometimes be a problem.  As with all of these procedures, a lot depends on the skill of the operator...

However, if getting an LV-pacing lead into the coronary sinus can't be done, it's not a complete blocker to getting you a third lead placed for CRT to have a chance.  It's possible to place a lead to the *outside* of the LV (these days done using an endoscopic approach, so no cracking the chest open) and then tunnel the lead up to the pocket where the PM/CRT sits.

Best wishes.

Thank you

by Rxrich - 2021-11-03 17:46:00

for the info on the different procedures. They will be replacing my 4th dual chamber PM and replacing it with a biventricular PM. I don't have a surgery date yet but it will be done sometime this month. I don't know if endoscopic will work for me. I notice the pacer is placed in a lower part of the body. Will stop worrying about it and wait for more info frm ep. Thank you so much for your input

R

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I just want to share about the quality of life after my pacemaker, and hopefully increase awareness that lifestyles do not have to be drastically modified just because we are pacemaker recipients.