Biventricular pacing via the femoral route: description of a novel approach

Abstract

Purpose Cardiac resynchronisation benefits patients with heart failure. Occasionally, the procedure is not possible from a superior approach. We encountered a patient with inaccessiblesubclavian veins and describe the implantation of a biventricular (biV) pacemaker via the femoral approach. Methods & Results A transverse incision was made 2cm above the right inguinal ligament and access to the femoral vein obtained. A long splittable Safesheath guiding catheter was advanced into the right atrium. Initial attempts at gaining access to the coronary sinus with 6F Amplatz catheters were unsuccessful, however, we were able to engage the coronary sinus ostium with a 6F multipurpose catheter. Sinography identified an ideal posterolateral tributary of the great cardiac vein into which an over-the-wire left ventricular lead was negotiated. Catheter support during left ventricular lead placement was excellent (panel A). Extra length active fixation leads were positioned on the high interventricular septum and in the right atrial appendage (panel B). After fixing to the deep inguinal fascia, the leads were reflected and tunnelled up into a mid abdominal pocket where a biV generator was implanted. Conclusion Our experience shows that inferior cannulation of the coronary sinus may offer particular advantages; e.g. ability of the catheter to straighten out curves leading to the coronary sinus. We therefore recommend that the femoral route be considered where subclavian access is not possible, or where the morphology of the coronary sinus precludes catheter approach from a superior approach. ![Figure][1] [1]: pending:yes