The Upgrade Strategy for a Patient with Implantable Cardioverter Defibrillator Complicated with the Total Occlusion of Left Subclavian Vein—The Usefulness of Subclavian Venoplasty

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Patients with implantable cardioverter defibrillator (ICD) refractory for the treatment of heart failure have been sometimes undergone upgrade operation for cardiac resynchronization therapy with defibrillator (CRTD). If the left subclavian vein occuluded totally, left ventricular (LV) lead should be added from opposite side. These procedure have been troublesome and invasive for patients with refractory heart failure. We experienced a case of ICD (full DDD pacing) complicated with the total occlusion of left subclavian vein which underwent subclavian venoplasty with percutaneous coronary intervention (PCI) system and successful LV lead insertion. A 56 years old male who was implanted DDD pacemaker for complete AV block in 1995, then underwent ICD implantation for ventricular fibrillation in 2005. He underwent the upgrade operation for CRTD because of uncontrollable ascites, which could be caused by medication-resistant right heart failure sign. Venography before LV lead insertion revealed the total occlusion of his left subclavian vein. We performed subclavian venoplasty using PCI system (guide wire: ULTIMATE Bros3, balloon catheter: Douvan 3.0–15, 14 atm ×4) and successfully inserted LV lead. Subclavian venoplasty is effective, less invasive and safe strategy for patients with total occlusion of subclavian vein to upgrade ICD to CRTD.