The first reported case of a transvenous left ventricular pacing lead of cardiac resynchronization therapy causing aggravation of coronary atherosclerosis

A 64-year-old male suffering from severe heart failure underwent implantation of a cardiac resynchronization therapy-defibrillator (CRT-D) 3 years ago. The tip of the bipolar left ventricular (LV) lead was pushed and wedged into a small branch of the coronary vein at the basal lateral position. Coronary arteriography (CAG) following CRT-D implantation did not show coronary stenosis but retrospectively uncovered a dimple in the left circumflex coronary artery (LCx) wall underneath the LV lead. Three years later, he experienced CRT-D discharge events for ventricular tachycardia (VT). Subsequent computer tomography and CAG revealed a configuration of the LV lead running upon the LCx and severe LCx stenosis at that point (Panels A and B). An intravascular ultrasound showed the stenosis as an atherosclerotic plaque. After a balloon angioplasty, the VT has not recurred during a 9-month follow-up period.

This case suggests that the long-term contact and pressure to the coronary artery wall can affect fluid shear stress and lead to the aggravation of coronary atherosclerosis. Therefore, when the position of the LV lead is determined or when a coronary lesion is suspected to have progressed, it is important to consider the influence of the implanted LV lead on coronary atherosclerosis.

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The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.