Abstract
A 68-year-old right-handed male with ischemic cardiomyopathy received a single-chamber implantable cardioverter-defibrillator (ICD; Gem DR 7271; Medtronic Inc., Minneapolis, MN) for sustained ventricular tachycardia. Seven years later, he was upgraded to a biventricular system (InSync Sentry 7299; Medtronic Inc.) with a transvenous bipolar left ventricular (LV) lead. Six months after the upgrade, routine monitoring detected noise from the right ventricular (RV) lead (Sprint 6942, Medtronic Inc.; Figure 1). The RV pacing threshold and impedance remained normal. The patient underwent an attempted new RV lead placement via a left arm approach. A venogram demonstrated a stenosis at the junction of the left subclavian vein and superior vena cava (Figure 2). Both left subclavian and axillary venous access were easily obtained. A standard 0.038” J wire would not cross the stenosis. A 0.035” Glidewire (Teramo/Boston Scientific) was able to pass the stenosis, but further dilatation or sheath placement was not possible. What would you do at this juncture?
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
