Biventricular pacing via a persistent XXXX : report of four cases.

@entity1 @entity4264 @entity301 @entity3032 @entity1146
Persistence of @entity4264 ( @entity4264 ) is an uncommon finding during pacemaker implantation, which may be particularly relevant in performing LV transvenous pacing. Rarely, it is further complicated by the presence of @entity301 (CSO). This article reports the authors experience with biventricular pacing ( @entity3032 -P) in this unusual clinical setting. From October 1999 to April 2002, 158 @entity1 underwent biventricular pacing. In four of them (mean age 62.2 years), the presence of a persistent @entity4264 draining into the coronary sinus (CS) was detected at implantation, associated with @entity1146 of the CSO in two @entity1 . A common characteristic was the angiographic finding of a large CS with few tributaries. The LV leads were successfully positioned in the middle cardiac vein in three @entity1 and in a posterolateral vein in one @entity1 . All vessels were large and their cannulation via downstream CS catheterization required the lead to be manipulated through sharp angles. Mean fluoroscopic exposure and procedural times were not significantly different from the overall @entity3032 -P population. In all @entity1 , at a mean follow-up of 11 months, sensing and capture threshold remained stable and a significant decrease in NYHA functional class and increase in LVEF were noted. The direct lead placement in large CS tributaries in the presence of persistent @entity4264 was feasible and safe. The leads remained stable up to a mean follow-up of nearly 1 year.
