Purpose of review
Due to complex venous anatomy and limitations in lead delivery tools and technology, the incidence of failed left-ventricular lead implants continues to be as high as 10%.
A move towards an interventional approach to left-ventricular lead implantation has provided viable alternatives to surgical lead implantation. The use of telescoping sheaths, gooseneck snares and percutaneous balloon venoplasty
may reduce procedural times by facilitating lead delivery despite challenging venous anatomy. In addition, recent advancements in left-ventricular lead technology
now allow implanting physicians to overcome commonly encountered obstacles such as high thresholds and phrenic nerve stimulation, without having to move the lead from a stable position. For those with suboptimal or inaccessible coronary vein targets, a simplified transseptal
endocardial implant approach has also been described.
These recent advances in implant techniques and left-ventricular lead technology
provide promising solutions to commonly encountered procedural obstacles in the implementation of resynchronization therapy. These alternative strategies will hopefully reduce the rate of failed implants and referrals for surgical epicardial leads.