Trans-septal left ventricular endocardial lead in a patient with extensive anterior myocardial infarction and left ventricle (LV) apical endoventriculoplasty using a Vascutek patch-case report.

Background: Cardiac resynchronization therapy (CRT) implantation has significantly improved quality of life and reduced overall mortality due to heart failure. The conventional method of CRT implantation is implanting a left ventricle (LV) lead into a side branch of the coronary sinus (CS) tributary to pace the epicardial surface and capture the LV. This is safe, and well tolerated with a high success rate. The rate of failure to place an LV lead has decreased over time, however, there are still challenging cases where a conventional CRT implant fails and alternative techniques are being considered, one such technique is trans-septal endocardial LV lead placement used to capture the LV, endocardially but its use is limited due to lack of evidence, practice uptake and clinical trials.

Case description: We present, a case report of a patient for whom we successfully used a trans-septal left ventricle (TSLV) endocardial lead implantation approach following a failed LV lead implant via the CS to get effective cardiac resynchronisation.

Conclusions: Post-TSLV lead implantation follow-up checks were normal with good electrical parameters and appropriate biventricular pacing. No post-procedural complications were reported, and echocardiographic parameters improved at follow-up. We believe, although, TSLV lead implant is more complex and often double operators are required, in selected patients, it can be a safe alternative following a failed traditional LV lead implant via the CS.