. Two months after implantation there was improvement of patient’s condition.
. Two months immediately after implantation there was improvement of patient’s condition. From electrokardiogram showed biventricular pacing. Atrial lead, RV lead and LV lead from chest xray was on right position. Ten months right after implantation she revealed DAA-1106 web shortness of breath throughout moderate activity and hoarse of voice but no history of seizure or syncope. Interrogation was performed to find the best tresshold and PR wave. After repetitive interrogation the electrokardiogram still showed proof of lost capture (no biventricular pacing). Earlier echocardiogram showed lowered LV contraction with LA (Left atrium) LV dilatation, moderate MR (mitral regurgitation) and intraventricular dysynchroni. Laboratory discovered no prolongation of prothrombin time and INR. Due to that, we decided to place the patient for LV lead replacement. Through the procedure, we found web pages of LV lead wire fractures at the proximal, mid and distal lead (Figure .A). Just before implant on the new lead, we tried to place out the LV lead wire initially. A number of instances we attempted to evacuate the lead wire (Figure .B), but only the proximal and also the mid lead wire was productive released. We decided to ignored a little bit part of fracture wire and decided to implant the new LV lead at posterolateral branch from preceding LV lead. But, the LV lead could not reach the CS due to restrained. We performed coronary venography and which showed serious stenosis at places, in the proximal coronary sinus (CS), first closed to thebesian valve along with the second in the proximalmid CS (figure .A anad .B). So, we tried to cannulated the CS with guidewires initially. Wiring at proximal until distal CS with runthrough NS and balance middle weight universal II was performed. Following effective wiring, predilatation with balon Sprinter at two side was accomplished at proximal CS with atm at sec and distal CS with atm at sec (figure C and D). LV lead was tried to place in at the CS but nonetheless could not enter the middistal CS so we planned for snaring strategy to picked up the lead from CS to the appropriate atrium (RA) (figure). Snaring method was performed to catch the lead wire from femoral vein. Lead wire was continued to become encouraged from proximaldistal CS and we planned to place extended sheath towards the RA (figure .A,B). Right after long sheath was profitable inserted in the RA, snare catheter was inserted from suitable femoral vein. LV lead wire was catched and holded on by snare catheter in the RA (figure .C). LV lead was effective implanted
at the posterolateral branch of coronary vein (figure .D). PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26296952 Right after implantation we discovered the new LV lead tresshold was V, present . mA, R wave . mV andAbstractsimpedance ohm. Just after the process, LV lead was connected to the generator. For the duration of process heparin was provided iv with adjusted dose from ACT. Antibiotic and skin closure was carried out right after that and also the patient was sent to recovery room with stablized situation. ConclusionNew tools and techniques have considerably enhanced the efficiency and achievement rate of LV lead placement. LV lead implantation most likely requirements to evolve from a strictly anatomically based process to a “targeted” implant method. Electrophysiologists should arm themselves using the most effective information prior to and in the course of the process to guide correct lead placement for every single patient. Modalities such speckletracking echocardiography to guide LV lead placement could be applied. In our case, combining technique has been created to optimalization the implantation lead. Conservative strategy for fractured wire of LV lead h.