First-in-Man Coronary Sinus Lead Stabilization Using a Bioresorbable Vascular Scaffold System.

Cardiac resynchronization therapy has become an integral part of treatment in patients presenting with reduced ventricular function (left ventricular ejection fraction <35%), clinically symptomatic dyspnea (New York Heart Association II–IV), and complete left bundle branch block. Currently, the standard approach of left ven-tricular lead placement is transvenously via the coronary sinus (CS). Although a wide range of CS leads, sheaths, and subselec-tors are available, peri-or postinterventional lead dislodgement is still a cause for placement failure. Interventional stabilization by metallic stents of the CS lead has been described, but there are concerns on mid-and long-term effects because of possible mechanical irritation. Here we describe the first case in which a bioresorbable vascular scaffold was used to stabilize a CS lead in a lateral side branch against the vessel wall. A 74-year-old man with dilated cardiomyopathy, New York Heart Association Class III, had an implantable cardioverter defibrillator placed in 2008 for primary prophylaxis of sudden cardiac death. In January 2015, the patient presented with worsening heart failure and a markedly decreased ejection fraction (left ventricular ejection fraction 20%). Bradyar-rhythmia (<40/min) resulted in dyssynchronous right ventric-ular apical pacing ≥95%. Decision to upgrade the patient's system to a cardiac resyn-chronization therapy system (St Jude Medical, PROMOTE CD3211-36, St Paul, MN) was made in line with current guidelines. 1 The venogramm revealed a huge CS with only one suitable lateral side branch with a 110° angle and a kinking at 1.5 cm followed by a distribution into 2 smaller branches (Figure 1). A quadripolar lead (St Jude Medical Quartet, St Paul, MN) became immediately dislodged. After changing the lead to a bipolar lead (St Jude Medical Quickflex μ 1258T, St Paul, MN), the proximal portion of the target branch was reached with good sensing and pacing values and no phrenic nerve capture, but dislodgement occurred again. However, despite the use of a stiff wire and an additional buddy wire (Galeo Pro; Biotronik, Berlin, Germany), the lead could not be further advanced to establish a stable position. We decided to introduce a 3.00×12 mm bioresorbable scaffold (Abbott, Absorb, North Chicago, IL) via a second simultaneous CS catheter (St Jude Medical CPS 115, St Paul, MN) into the proximal portion of the side branch in an attempt to stabilize the lead against the side of the vessel and prevent its dislodgement. The scaffold was positioned directly proximally to the second electrode. The balloon was inflated for 60 …