Left ventricular lead stabilization in coronary sinus via stent case report and literature review

Background: Left ventricular lead instability encounters some cardiac resynchronization therapy implantations affecting heart failure patient's responsiveness. We present a left ventricular lead stabilization in the coronary sinus via a drug-eluting stent in addition to the literature review of this technique. Methods: A 33-year-old male patient had advanced heart failure and implanted cardiac resynchronization therapy. Left ventricular lead dislocation mandated redo-implantation. Lead instability complicated the procedure until a drug-eluting stent anchored it in the posterolateral branch of the coronary sinus. Furthermore, we reviewed the literature to address all studies and reports of left ventricular lead stabilization via coronary stent in the coronary sinus during cardiac resynchronization therapy implantation. We explored words as left ventricular lead stabilization, lead stenting, coronary sinus stent, coronary sinus angioplasty. Results: A total of 14 studies spotted left ventricular lead stenting in the coronary sinus during biventricular pacing between 2000 and 2021; four observational studies: three case series: seven case reports. The studies included 400 patients, and mean follow-up was 20 months. Stenting the lead during the primary procedure (n=368) versus stenting in the redo procedure (n=32). Stenting for lead instability and phrenic nerve stimulation (n=374), whereas stenting due to unfavorable anatomy (n=26). Most patients received a bare-metal stent (n=396), a drug-eluting stent (n=2), and a bioabsorbable scaffold (n=2). Overall reported stenting the left ventricular lead since the first procedure description in years 2003 to 2011 was 390 stents and between the years 2012–2021 was ten stents. Conclusion: During cardiac synchronization therapy implantation, left ventricular lead retention in the coronary sinus by stent is feasible and effective.