Use of Support Catheter for LV Lead Placement in Challenging Biventricular Implant

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Introduction: Unfavourable Coronary sinus (CS) anatomy and lack of guide wire support make CRT implantation difficult in some cases. We describe a novel technique to obtain CS cannulation based on a combined use of an Amplatz guiding catheter and Quick cross support catheter to create a progressively supportive rail to advance the LV lead. Methods: The CS was cannulated with 6 Fr. Amplatz (AL2) guiding catheter and an exchange length 0.035 straight tip standard Terumo guide wire placed in distal CS. A 135 cm Spectranetics QuickCross support catheter (518 037, with a proximal shaft diameter of 4.8 Fr. tapering to a distal shaft diameter of 3.8 Fr.) was advanced through AL2 guiding over the Terumo guide wire into distal CS. Terumo guide wire was changed to 0.035 standard Jtip PTFE guide wire, keeping support catheter in place. The proximal luer fitting of support catheter was cut and a Medtronic inner sheath (ATTAIN SELECT II) advanced over support catheter into the mid CS. A 4 Fr. LV lead was advanced over 0.014PTCA wire through inner sheath after removal of support catheter and 0.035 guide wire. Conclusions: Support catheter can be used as anchor to facilitate CS cannulation and LV lead placement in patients with difficult venous anatomy.