Stabilization of a dislocated coronary sinus electrode by coronary stenting during resynchronization therapy

Cardiac resynchronization therapy (CRT) is an effective treatment in patients with severe refractory heart failure combined with intraventricular conduction disease, improving quality of life and decreasing mortality. In CRT, pacing of the left ventricle is accomplished by a coronary sinus (CS) electrode. The main challenge for this technique is to achieve and maintain an optimal lead position so that no dislocation occurs. Cardiac resynchronization therapy was planned in a 66-year-old male patient with NYHA (New York Heart Association) class 3-4 symptoms and left bundle branch block. After two dislocations of the pacing lead from the posterolateral CS, the lead was implanted in the middle cardiac vein and stabilized by coronary stenting. During a six-month follow-up, no further dislocation occurred and pacing parameters were normal.

Keywords: Electrodes, implanted, heart failure/therapy, pacemaker, artificial; prosthesis failure; prosthesis implantation; stents.