. Two months right after implantation there was improvement of patient’s situation. From electrokardiogram showed biventricular pacing. Atrial lead, RV lead and LV lead from chest xray was on appropriate position. Ten months after implantation she revealed shortness of breath through moderate activity and hoarse of voice but no history of seizure or syncope. Interrogation was done to seek out the very best tresshold and PR wave. Just after MedChemExpress Microcystin-LR repetitive interrogation the electrokardiogram nonetheless showed evidence of lost capture (no biventricular pacing). Previous echocardiogram showed lowered LV contraction with LA (Left atrium) LV dilatation, moderate MR (mitral regurgitation) and intraventricular dysynchroni. Laboratory discovered no prolongation of prothrombin time and INR. Because of that, we decided to place the patient for LV lead replacement. During the procedure, we found sites of LV lead wire fractures in the proximal, mid and distal lead (Figure .A). Ahead of implant from the new lead, we tried to place out the LV lead wire initial. Many times we attempted to evacuate the lead wire (Figure .B), but only 
the proximal and the mid lead wire was effective released. We decided to ignored a little part of fracture wire and decided to implant the new LV lead at posterolateral branch from preceding LV lead. But, the LV lead couldn’t reach the CS due to restrained. We performed coronary venography and which showed severe stenosis at locations, in the proximal coronary sinus (CS), very first closed to thebesian valve along with the second at the proximalmid CS (figure .A anad .B). So, we tried to cannulated the CS with guidewires very first. Wiring at proximal till distal CS with runthrough NS and balance middle weight universal II was accomplished. Following prosperous wiring, predilatation with balon Sprinter at two side was carried out at proximal CS with atm at sec and distal CS with atm at sec (figure C and D). LV lead was attempted to put in at the CS but nevertheless could not enter the middistal CS so we planned for snaring strategy to picked up the lead from CS towards the correct atrium (RA) (figure). Snaring method was performed to catch the lead wire from femoral vein. Lead wire was continued to be encouraged from proximaldistal CS and we planned to put long sheath for the RA (figure .A,B). After lengthy sheath was effective inserted in the RA, snare catheter was inserted from correct femoral vein. LV lead wire was catched and holded on by snare catheter at the RA (figure .C). LV lead was effective implanted
at the posterolateral branch of coronary vein (figure .D). PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26296952 Soon after implantation we found the new LV lead tresshold was V, existing . mA, R wave . mV andAbstractsimpedance ohm. Right after the procedure, LV lead was connected to the generator. In the course of procedure heparin was given iv with adjusted dose from ACT. Forsythigenol Antibiotic and skin closure was completed immediately after that and also the patient was sent to recovery space with stablized condition. ConclusionNew tools and procedures have significantly enhanced the efficiency and success rate of LV lead placement. LV lead implantation probably requirements to evolve from a strictly anatomically based procedure to a “targeted” implant method. Electrophysiologists must arm themselves using the very best information prior to and through the procedure to guide right lead placement for every single patient. Modalities such speckletracking echocardiography to guide LV lead placement is usually used. In our case, combining technique has been developed to optimalization the implantation lead. Conservative tactic for fractured wire of LV lead h.. Two months right after implantation there was improvement of patient’s situation. From electrokardiogram showed biventricular pacing. Atrial lead, RV lead and LV lead from chest xray was on appropriate position. Ten months after implantation she revealed shortness of breath in the course of moderate activity and hoarse of voice but no history of seizure or syncope. Interrogation was accomplished to locate the best tresshold and PR wave. Immediately 
after repetitive interrogation the electrokardiogram still showed evidence of lost capture (no biventricular pacing). Earlier echocardiogram showed reduced LV contraction with LA (Left atrium) LV dilatation, moderate MR (mitral regurgitation) and intraventricular dysynchroni. Laboratory identified no prolongation of prothrombin time and INR. Due to that, we decided to put the patient for LV lead replacement. Through the procedure, we identified internet sites of LV lead wire fractures in the proximal, mid and distal lead (Figure .A). Ahead of implant from the new lead, we attempted to put out the LV lead wire initially. Quite a few times we tried to evacuate the lead wire (Figure .B), but only the proximal along with the mid lead wire was successful released. We decided to ignored a little bit part of fracture wire and decided to implant the new LV lead at posterolateral branch from earlier LV lead. But, the LV lead couldn’t reach the CS because of restrained. We performed coronary venography and which showed extreme stenosis at places, at the proximal coronary sinus (CS), initial closed to thebesian valve and the second in the proximalmid CS (figure .A anad .B). So, we attempted to cannulated the CS with guidewires initially. Wiring at proximal till distal CS with runthrough NS and balance middle weight universal II was performed. Right after profitable wiring, predilatation with balon Sprinter at two side was accomplished at proximal CS with atm at sec and distal CS with atm at sec (figure C and D). LV lead was tried to place in in the CS but nevertheless could not enter the middistal CS so we planned for snaring strategy to picked up the lead from CS for the correct atrium (RA) (figure). Snaring approach was performed to catch the lead wire from femoral vein. Lead wire was continued to be encouraged from proximaldistal CS and we planned to put extended sheath for the RA (figure .A,B). Following extended sheath was thriving inserted at the RA, snare catheter was inserted from right femoral vein. LV lead wire was catched and holded on by snare catheter in the RA (figure .C). LV lead was thriving implanted
at the posterolateral branch of coronary vein (figure .D). PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26296952 Right after implantation we located the new LV lead tresshold was V, current . mA, R wave . mV andAbstractsimpedance ohm. Right after the process, LV lead was connected to the generator. Through procedure heparin was provided iv with adjusted dose from ACT. Antibiotic and skin closure was carried out immediately after that plus the patient was sent to recovery area with stablized condition. ConclusionNew tools and procedures have significantly enhanced the efficiency and success rate of LV lead placement. LV lead implantation likely wants to evolve from a strictly anatomically primarily based procedure to a “targeted” implant technique. Electrophysiologists ought to arm themselves using the most effective information prior to and throughout the procedure to guide proper lead placement for every patient. Modalities such speckletracking echocardiography to guide LV lead placement might be employed. In our case, combining technique has been created to optimalization the implantation lead. Conservative tactic for fractured wire of LV lead h.
