Left ventricular lead deployment using a transfemoral approach with subcutaneous tunnelling to a prepectoral pocket: a novel approach for upgrading to cardiac resynchronization therapy

Abstract

We describe a case of upgrading an existing dual-chamber prepectoral pacemaker to cardiac resynchronization therapy (CRT) with bilaterally inaccessible subclavian veins in an 81-year-old man on haemodialysis with New York Heart Association III heart failure, but no known evidence of ischaemia. Echocardiography revealed severely impaired left ventricular (LV) function. The intrinsic QRS duration was 127 ms with right-ventricular pacing 78% of the time. A …