Coronary sinus lead placement via the internal jugular vein in patients with advanced heart failure: a simplified percutaneous approach.

BACKGROUND: Placement of coronary sinus (CS) leads is usually achieved via the left cephalic-axillary-subclavian (CAS) venous system. In some cases, however, such as lack of venous access a right side approach is required. Cannulation of the CS via the right CAS vein is often technically difficult, leaving the right IJ vein as a suitable alternative.
OBJECTIVE: The feasibility of IJ vein as a conduit for transvenous left ventricular (LV) pacing in patients with heart failure (HF) has not been reported. METHODS AND
RESULTS: Between July 2002 and April 2004, we implanted 339 biventricular devices in patients with moderate-to-severe HF. In 15 patients with similar clinical characteristics, in whom the left CAS vein could not be used, the CS leads were placed via the right CAS venous system (n = 5) or the IJ vein (n = 10). The ten patients (6 men and 4 women; age 66 +/- 15 years; LV ejection fraction .19 +/- .07; QRS duration 183 +/- 35 ms) who required IJ CS lead placement had no procedure related complications and all retained appropriate LV pacing and showed significant improvement in HF symptoms after a median follow-up of 12 months (6 to 22 months).
CONCLUSIONS: Thus, in patients with HF for whom the traditional CAS venous approach cannot be used (left side) or is technically difficult (right side), CS leads can be deployed safely via the right IJ vein. In these situations, it seems appropriate to consider this approach prior to the more invasive epicardial approaches.