187: Interest of a simple method for coronary sinus lead tunneling from controlateral to homolateral subclavian vein in upgrading indications

Abstract

Introduction We developed the usage of a simple tunnelling method from controlateral access to the device in case of homolateral subclavian access failure when an additional lead is needed. Goal of the study long term evaluation of feasibility and safety of this tunneling strategy. Method From September 1998 to September 2011, a coronary sinus (CS) lead was implanted through controlateral access after failure of homolateral to the device implantation in 31 consecutive patients (19 males 72+/- 8 yo). Indications were thrombosis 14 and failure to catheterize CS 17. All these patients were already implanted with a single or double chamber pacemaker or internal cardiac defibrillator and were referred for upgrading to biventricular pacing. The packaging sheath of a simple conventional catheter (plastimed) was introduced from one side to the other under local anesthesia after scissors dissection under local anesthesia. Tunneling of coronary sinus lead was performed through the sheath which was then withdrawed. Results Success tunneling procedure rate was 100%. Tunelling time was 3+/-2 mn. Complications related to the procedure: 2 cases of xylocaine overdose needed temporary ventilation assistance at beginning of experience. 1 early dislodgment needed replacement, 2 cases of early battery wear because of low impedance of the cs lead. No hematoma, no acute or late pain complain, no lead infection were reported. Conclusion Controlateral implantation through a simple packaging sheath is a simple and safe option in case of homolateral access failure in upgrading indications.