Maneuvering balloon occlusion technique to deflect LV lead into a target branch during CRT implantation

  • Ahmed Al Fagih
  • Saleh Al Ghamdi
  • K. Dagriri
  • Adil Ahmed
  • Ayman Al Khadra
Case Report


Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy (DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of a 45-year-old woman with DCM requiring lead placement is presented here. To plan for proper LV lead positioning, CS angiography was obtained through right femoral vein approach with preshaped long sheath (SJM, SL3) and occlusive balloon. For successful implant of LV lead, with no viable alternatives available, the tortuosity of the lateral and posterolateral branch were overcome by advancing and inflating the balloon in the main CS to deflect LV lead into the target branch. A unipolar LV lead (Medtronic 4193) was finally placed in a true posterolateral position with excellent sensing and pacing threshold without phrenic nerve stimulation.


Cardiac resynchronization therapy Coronary sinus Dilated cardiomyopathy Balloon occlusion technique 



Cardiac resynchronization therapy


Coronary sinus


Dilated cardiomyopathy


Left ventricular


Left ventricular ejection fraction


New York Heart Association


Right ventricular


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Ahmed Al Fagih
    • 1
  • Saleh Al Ghamdi
    • 2
  • K. Dagriri
    • 2
  • Adil Ahmed
    • 2
  • Ayman Al Khadra
    • 2
  1. 1.Prince Sultan Cardiac CenterRiyadhSaudi Arabia
  2. 2.Prince Sultan Cardiac CenterRiyadhSaudi Arabia

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