Middle Cardiac Vein Pacing Avoids Phrenic Nerve Stimulation, Offers Optimal Resynchronization and Obviates Surgery for Epicardial Lead Placement

A 64-year old patient with refractory heart failure had a biventricular pacing system implanted with the LV lead placed at a posterolateral coronary sinus branch at another hospital but it was complicated by phrenic nerve stimulation. At a repeat procedure, this time in our hospital, cannulation was attempted, and finally achieved, albeit with difficulty, of the middle cardiac vein and the pacing lead was successfully placed at an apical posterolateral position. Pacing and sensing thresholds were excellent. This strategy obviated open thoracotomy for lead placement which would otherwise have been the only option available