PMID- 36819886
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230224
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 2
DP  - 2023 Feb
TI  - Retrograde venography to navigate an occluded subclavian vein to achieve cardiac 
      resynchronization therapy upgrade via His bundle pacing: a case report.
PG  - ytad016
LID - 10.1093/ehjcr/ytad016 [doi]
LID - ytad016
AB  - BACKGROUND: Guidelines support upgrade to cardiac resynchronization therapy (CRT) 
      through His-bundle pacing (HBP) in pacing-induced cardiomyopathy and moderate 
      left ventricular systolic dysfunction (LVSD). Lead-related venous occlusion can 
      represent an obstacle to upgrade procedures. We describe a technique to overcome 
      venous occlusion through direct puncture of a collateral vein facilitating 
      upgrade to HBP. CASE SUMMARY: An 84-year-old man with a right ventricular (RV) 
      pacemaker was referred with New York Heart Association (NYHA) Class III 
      breathlessness secondary to moderate LVSD (left ventricular ejection fraction 
      [LVEF] 45%). Device interrogation revealed 100% RV pacing and AV-dyssynchrony. To 
      optimize atrioventricular (AV) and interventricular (VV) synchrony a CRT upgrade 
      with HBP was planned. Venography revealed an occluded left subclavian vein which 
      was probed in a retrograde manner using a 6F MPA catheter from right femoral 
      venous access. We were able to direct the catheter distal to the left 
      brachio-cephalic vein and define the occlusion using contrast. A collateral 
      branch was identified, a J-wire was left in this branch and venous access was 
      secured at this medial subclavian site using the Seldinger technique. A right 
      atrial lead was deployed and 69 cm ISI-1 His lead was deployed via a C315 sheath 
      at the His-bundle. The resulted in non-selective HBP (Stim-QRS end 146 ms). There 
      were no procedural complications. Two months later both symptoms and LV function 
      (LVEF 55%) improved. DISCUSSION: Lead-related venous occlusion occurs frequently 
      and can be probed in a retrograde manner from femoral venous access using 
      contrast, facilitating direct percutaneous puncture of collateral venous branches 
      to allow upgrade to CRT via HBP.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Pavitt, Christopher
AU  - Pavitt C
AUID- ORCID: 0000-0001-5067-8248
AD  - Sussex Cardiac Centre, Royal Sussex County Hospital, University Hospitals Sussex 
      NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK.
FAU - Luther, Vishal
AU  - Luther V
AD  - Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation 
      Trust, 72 Du Cane Road, London W12 0HS, UK.
FAU - Lefroy, David
AU  - Lefroy D
AD  - Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation 
      Trust, 72 Du Cane Road, London W12 0HS, UK.
FAU - Tanner, Mark
AU  - Tanner M
AD  - Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation 
      Trust, 72 Du Cane Road, London W12 0HS, UK.
AD  - Cardiology Department, St Richard's Hospital, University Hospitals Sussex NHS 
      Foundation Trust, Spitalfield Lane, Chichester PO19 6SE, UK.
LA  - eng
PT  - Case Reports
DEP - 20230111
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC9927565
OTO - NOTNLM
OT  - Cardiac resynchronization therapy
OT  - Case report
OT  - His-bundle pacing
OT  - Venous occlusion
COIS- Conflict of interest: None declared.
EDAT- 2023/02/24 06:00
MHDA- 2023/02/24 06:01
PMCR- 2023/01/11
CRDT- 2023/02/23 10:08
PHST- 2022/05/03 00:00 [received]
PHST- 2022/07/13 00:00 [revised]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/02/23 10:08 [entrez]
PHST- 2023/02/24 06:00 [pubmed]
PHST- 2023/02/24 06:01 [medline]
PHST- 2023/01/11 00:00 [pmc-release]
AID - ytad016 [pii]
AID - 10.1093/ehjcr/ytad016 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Jan 11;7(2):ytad016. doi: 10.1093/ehjcr/ytad016. 
      eCollection 2023 Feb.