Left ventricular pacing lead positioning in the target vein of the coronary sinus: Description of a challenging case

Folco Frattini, Roberto Rordorf, Luigi Angoli, Francesco Pentimalli, Alessandro Vicentini, Barbara Petracci, Giulia Magrini, Maurizio Landolina

Research output: Contribution to journalArticlepeer-review


The optimal left ventricular pacing location for cardiac resynchronization therapy should be individualized according to the site of maximal mechanical delay. However, the presence of vein stenosis or kinking in coronary sinus (CS) anatomy could hamper lead implantation in the target vessel. We describe the case of a patient with dilated cardiomyopathy and a dual-chamber pacemaker referred for upgrading to a biventricular device owing to New York Heart Association III heart failure symptoms. Tissue Doppler analysis before implantation showed that the area of maximum activation delay was located in the posterolateral region of the left ventricle. Insertion of the lead into a posterolateral vein of the CS by means of the standard over-the-wire approach was unsuccessful due to the presence of a stenosis at the ostium of the vein. Lead placement in an anterior vein of the CS was unsatisfactory owing to a poor local delay from QRS onset. After balloon vein angioplasty, the pacing lead passed through the stenotic tract at the ostium of the target vein and was successfully positioned in the posterolateral region. Three months after pacemaker implantation, echocardiography showed an important reduction in the indexes of both inter- and intraventricular asynchrony and a significant left ventricular reverse remodeling.

Original languageEnglish
Pages (from-to)503-505
Number of pages3
JournalPACE - Pacing and Clinical Electrophysiology
Issue number4
Publication statusPublished - Apr 2008


  • Balloon vein angioplasty
  • Cardiac resynchronization therapy
  • Pacing lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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