Observational Study of Trans-Septal Endocardial Left Ventricle Lead Implant for Effective Cardiac Resynchronization Therapy in Patients with Heart Failure and Challenging Coronary Sinus Anatomy.

Background: When conventional trans-venous CS lead placement fails, trans-septal endocardial left ventricle lead placement is an alternative technique used to capture the left ventricle endocardially; however, its use is limited due to a lack of evidence, practice uptake, and clinical trials.

Methods: In this single-center cohort study, we evaluated the efficiency of the procedure, post-procedural complication rate, rate of thromboembolic events, overall survival rate, and changes in the echocardiographic parameters, brain natriuretic peptide (BNP) level, and New York Heart Association (NYHA) class, both before and after TSLV lead implantation.

Results: The TSLV lead implant is safe and improves EF, LVEDV, LVESV, and LVIDd. It significantly reduces the NTproBNP levels and the NYHA class; however, the rate of stroke incidence remains high, at 9%.

Conclusions: We demonstrated a high success rate of trans-septal left ventricular endocardial lead implantation, LV reverse remodeling was noted, and patients had a favorable clinical response; however, there was an increased risk of systemic embolization after the trans-septal LV lead implant.