Upgrading patients with chronic defibrillator leads to a biventricular system and reducing patient risk: contralateral LV lead placement.

Increasing numbers of patients with indwelling single- or dual- chamber internal cardioverter defibrillators (ICDs) will require upgrading of an existing system to a biventricular ICD providing cardiac resynchronization with back-up defibrillation. Upgrading, usually by the addition of a new left ventricular (LV) lead, can be technically challenging with central venous occlusion or stenosis often being the main obstacle to a successful procedure. We report a new technique of implanting a LV lead from the contralateral side to the existing ICD system to minimize the peri- and postoperative risk to the patient.