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In a 68 year old male patient with advanced refractory heart failure we engaged both the coronary sinus (CS) os and an appropriate side branch using an external magnet based system (Stereotaxis, St Louis, Missouri, USA) and a modified 0.014 guide wire equipped with a single magnet in the tip (Cronus Floppy Endovascular Guide wire, Stereotaxis). This was done without a sheath in the atrium, after having performed coronary angiography with late phase runs to demonstrate the anatomy of the CS. Markers were placed on the images (panels A and B) using the Stereotaxis NavigantTM navigation system and two radiographic views (26° RAO and 26° LAO—the maximum allowed by the large external magnets). With the external magnets and target based navigation, the Cronus wire was advanced into the CS and then into a side branch with vector based navigation (panel C). Advancement of the pacing lead (ELA Situs OTW UW28D, ELA Medical, Le Plessis-Robinson Cedex, France) in the selected side branch was somewhat complicated by a lack of stiffness of the guide wire with some buckling at the caval—right atrial junction and within the right atrium (supplemental file posted online). Use of this technique, with the ability to design different guide wires more suited to magnetic navigation, may remove some of the obstacles to LV lead placement such as the risk of dissection or perforation, or lead displacement during sheath removal.
Review history and Supplementary material
A video accompanies this article.
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- [View Video] - Advancement of the pacing lead (ELA Situs OTW UW28D, ELA Medical, Le Plessis-Robinson Cedex, France) in the selected side branch was somewhat complicated by a lack of stiffness of the guide wire with some buckling at the caval�right atrial junction and within the right atrium.
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