Different venous angioplasty manoeuvres for successful implantation of CRT devices.

Aims: Cardiac resynchronization therapy (CRT) has growing impact in the treatment of severe heart failure Stenosis of coronary veins, complex structure of coronary sinus and occlusions of subclavian veins can limit lead passage in the target vein.
Methods and Results: Retrospective analysis of 705 implantation procedures of CRT devices from 1999 to July 2007 in a single centre to show the impact of venous angioplasty manoeuvres for successful placement of left ventricular lead. In 31 patients (3.5%) venous angioplasty was performed for LV-lead placement: 24 coronary veins (balloons 2.5-4.0 mm), 4 subclavian veins, 3 valves in the coronary sinus and one Marshall vein were dilated. Ring like strictures of coronary veins made high inflation pressures (16 +/- 4 atm) necessary. Success rate of LV lead placement were 99%. Complications were rare.
Conclusions: Angioplasty of coronary or subclavian veins and valve structures of coronary sinus are a useful and safe tool for successful lead placement. The use of balloons of 3.0mm in size usually allows implantation of at least a unipolar lead.