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Late Fragmentation of Coronary Sinus Lead and Perforation with Retained Guide Wire after Cardiac Resynchronization Therapy

Aman Makhija, Arun Mohanty, Raja Ram Mantri

Passive fixation of coronary sinus leads is an imperfect technique with a high incidence of intraoperative and post-operative dislocations. The retained guide wire technique has been proposed for stabilizing the left ventricular lead. Long term effects of retained guide wire on lead parameters are unknown. We describe two cases in which guide wire was retained in coronary sinus lead because of recurrent intraoperative lead dislocations. Both patients at 9-12 months of followup showed marked rise in left ventricular lead impedance with loss of capture. Fluoroscopy revealed multiple sites of lead fragmentation. The retained guide wire causes lead degradation and should be removed.