The 9 French sheath was placed over the long retained glidewire in the axillary vein under fluoroscopic guidance. Under fluoroscopic guidance, the CS was cannulated with the sheath using a steerable decapolar catheter and the CS introducer sheath was advanced into the CS. The glide wire was removed. Given the patient was not going to have an RV lead to avoid crossing the new TTVR, we discussed with the team and all agreed to attempt to place two leads in the CS (a bipolar sensing lead and a quadrapolar pacing lead). The whisper wire was preloaded on a bipolar sensing lead. The whisper wire and lead were advanced. An anterolateral branch was cannulated and the lead was advanced. Impedance and pacing thresholds were checked and felt to be adequate. The sheath was then split.
A new glidewire was advanced to the IVC through the same 9F short sheath in the axillary vein. Under fluoroscopic guidance, the CS was cannulated with the sheath using a steerable decapolar catheter and the CS introducer sheath was advanced into the CS. The glide wire was removed. A single venogram was performed through the main CS sheath revealing two lateral target vessels. A Whisper wire was able to cannulate a lateral CS branch but the lead would not advance in the sheath. We then used an inner CS guiding sheath. This lateral CS branch was recannulated with the whisper wire. This wire was advanced and the CS lead was advanced into the wedge position. Impedance and pacing thresholds were checked and felt to be adequate. The inner sheath and outer sheath were split with minimal movement of the CS lead.
A new glidewire was advanced to the IVC through the same 9F short sheath in the axillary vein. Under fluoroscopic guidance, the CS was cannulated with the sheath using a steerable decapolar catheter and the CS introducer sheath was advanced into the CS. The glide wire was removed. A single venogram was performed through the main CS sheath revealing two lateral target vessels. A Whisper wire was able to cannulate a lateral CS branch but the lead would not advance in the sheath. We then used an inner CS guiding sheath. This lateral CS branch was recannulated with the whisper wire. This wire was advanced and the CS lead was advanced into the wedge position. Impedance and pacing thresholds were checked and felt to be adequate. The inner sheath and outer sheath were split with minimal movement of the CS lead.
- Successful CRT-P implant with 2 CS leads (A port capped, RV port is the bipolar sensing lead in the anterolateral CS, LV port is the quadrapolar pacing lead in the CS lateral / posterolateral branch)
- There were no complications