Umiejętności z zakresu kardiologii interwencyjnej ułatwiają osiągnięcie sukcesu w elektroterapii

Background: Cardiac resynchronisation therapy is a therapeutic method with documented effectiveness improving outcomes both in prolong longevity, reducing hospitalization and improving quality of life. Left ventricular lead implantation in vast majority of cases is relatively easy but in some cases of anatomic conditions, turtuosity and stenosis of epicardial veins procedure requires customized techniques and tools. Material and methods: The case report presents a patient with persistent left superior vena cava in whom cardiac resynchronization therapy pacemaker was successfully implanted. Results: Fifty nine years old male with a history of dual-chamber (DDD) pacemaker implantation in 2007 due to atrio-ventricular block III° underwent coronary artery by-pass surgery (LIMA->LAD) in 2016 with simultaneous aortic valve replacement was admitted to hospital for pacemaker exchange due to battery exhaustion. Because of decrease of left ventricular ejection fraction to 30% decision to up-grade system to resynchronization one was taken. In patient the presence of isolated persistent left superior vena cave has been confirmed by peripheral venogram. Because of expected difficulties in extraction of former right ventricular pacing lead and implantation of right ventricular defibrillation form left side access the decision to up-grade system to resynchronisation pacemaker from the left side was made. Left ventricular lead implantation was possible through application of various tools and techniques which required experience in invasive cardiology. The paper describe in details the tools and techniques used. Conclusion: Broad knowledge of techniques and tools commonly used in invasive cardiology can facilitate implantation of left ventricular lead in difficult cases.