Utility of Active Fixation Lead in Unstable Left Ventricular Lead Positions in the Coronary Sinus for Left Ventricular Stimulation

History

The patient had recurrent hospital admissions for heart failure despite optimal tolerable medical therapy. He had a left ventricular ejection fraction of 25% and mechanical dyssynchrony on tissue Doppler echocardiogram. He also had documented nonsustained ventricular tachycardia and paroxysmal atrial fibrillation on Holter monitoring.

Current Medications

The patient was taking warfarin 0.125 mcg/daily, furosemide 40 mg twice daily, carvedilol 12.5 mg twice daily, aldactone 25 mg daily, digoxin 0.125 mg daily, simvastatin 20 mg daily, and valsartan 80 mg daily.

Current Symptoms

Recurrent admissions for heart failure. Significantly breathless at mild exertion (New York Heart Association class III).

Physical Examination

• BP/HR: 100/70 mm Hg/96 bpm

• Height/weight: 167 cm/60 kg

• Neck veins: Distended

• Lungs/chest: Bilateral crepitations

• Heart: Enlarged

• Abdomen: Ascites

Laboratory Data

• Hemoglobin: 11.1 g/dL

• Hematocrit/packed cell volume: 32%

• Mean corpuscular volume: 20.7 fL

• Platelet count: 167 × 10 ³ /µL

• Sodium: 141 mmol/L

• Potassium: 4.3 mmol/L

• Creatinine: 89 mmol/L

• Blood urea nitrogen: 7.5 mmol/L