. Two months immediately after implantation there was improvement of patient's situation.. Two months following

. Two months immediately after implantation there was improvement of patient’s situation.
. Two months following 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 correct position. Ten months after implantation she revealed shortness of breath during moderate activity and hoarse of voice but no history of seizure or syncope. Interrogation was performed to find the very best tresshold and PR wave. Right after repetitive interrogation the electrokardiogram still showed proof of lost capture (no biventricular pacing). Prior echocardiogram showed reduced LV contraction with LA (Left atrium) LV dilatation, moderate MR (mitral regurgitation) and intraventricular dysynchroni. Laboratory found no prolongation of prothrombin time and INR. As a result of that, we OICR-9429 decided to put the patient for LV lead replacement. During the process, we identified websites of LV lead wire fractures at the proximal, mid and distal lead (Figure .A). Prior to implant from the new lead, we tried to put out the LV lead wire very first. A number of times we attempted to evacuate the lead wire (Figure .B), but only the proximal plus the mid lead wire was productive released. We decided to ignored somewhat a part of fracture wire and decided to implant the new LV lead at posterolateral branch from prior LV lead. But, the LV lead could not reach the CS as a result of restrained. We performed coronary venography and which showed severe stenosis at locations, at the proximal coronary sinus (CS), first closed to thebesian valve and the second at the proximalmid CS (figure .A anad .B). So, we tried to cannulated the CS with guidewires 1st. Wiring at proximal until distal CS with runthrough NS and balance middle weight universal II was accomplished. Immediately after prosperous wiring, predilatation with balon Sprinter at two side was performed at proximal CS with atm at sec and distal CS with atm at sec (figure C and D). LV lead was tried to put in in the CS but nevertheless could not enter the middistal CS so we planned for snaring method to picked up the lead from CS for the appropriate atrium (RA) (figure). Snaring strategy was performed to catch the lead wire from femoral vein. Lead wire was continued to be encouraged from proximaldistal CS and we planned to place extended sheath to the RA (figure .A,B). Just after lengthy sheath was productive inserted at the RA, snare catheter was inserted from proper 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 Following implantation we located the new LV lead tresshold was V, current . mA, R wave . mV andAbstractsimpedance ohm. After the procedure, LV lead was connected towards the generator. In the course of procedure heparin was provided iv with adjusted dose from ACT. Antibiotic and skin closure was carried out just after that along with the patient was sent to recovery space with stablized condition. ConclusionNew tools and approaches have tremendously improved the efficiency and accomplishment price of LV lead placement. LV lead implantation most likely wants to evolve from a strictly anatomically based process to a “targeted” implant method. Electrophysiologists should really arm themselves with the greatest data prior to and during the procedure to guide suitable lead placement for each and every patient. Modalities such speckletracking echocardiography to guide LV lead placement could be employed. In our case, combining approach has been created to optimalization the implantation lead. Conservative strategy for fractured wire of LV lead h.