CRT in "buttocks": rare approach for complicated scenarios
Figure: A, coronary venous anatomy, B and C, all 3 leads in situ, D, CRT device in pelvic location
A case report published by Chousou et al in European Heart Journal represents the first reported case of an octogenarian female who underwent cardiac resynchronization device therapy via iliofemoral route for managing refractory heart failure. Conventional approach via upper limb veins was unsuitable as she was on haemodialysis via a combination of left-sided fistula and right-sided tunnelled line. CRT through iliofemoral approach was the only bailout option deemed fit for the patient.
An 89-year-old female with severely impaired left ventricular function (ejection fraction biplane 27%) due to coronary artery disease, diabetes, and end-stage renal failure on haemodialysis, experienced repeated hospitalization due to heart failure decompensation. Electrocardiogram demonstrated sinus rhythm with broad left bundle branch block (QRS duration 158 ms). Biventricular pacing was considered, but conventional approach via upper limb veins was unsuitable as she was on haemodialysis via a combination of left-sided fistula and right-sided tunnelled line. She was initially managed conservatively, as it was felt her comorbidities and vascular access concerns meant exposing her to the risks of complex device insertion was not in the patient's best interest.
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