A new technique for the transvenous implantation of the over-the-wire left ventricular pacing lead in a patient with heart failure.

Implantation of left ventricular leads (LV) for biventricular pacing remains a technological challenge and failure of the procedure is not uncommon. We described a 58 year-old patient with heart failure and intraventricular conduction delay where difficulty is encountered when cannulating the coronary sinus by the guiding catheter. By placing a guiding catheter in the inferior portion of the right atrium, a coronary guidewire, preloaded with an over-the-wire lead system, was used to reach the lateral cardiac vein. This may help to reduce the implant failure rate and avoid other more invasive means of LV lead implantation.