Safety and efficacy of orthodromic snare technique in left ventricular lead delivery in cardiac resynchronization implantation

Background: Cardiac resynchronization therapy (CRT) improves ventricular function, but a positive response to CRT is often limited due to left ventricular (LV) lead placement in a suboptimal position. Complex coronary venous anatomy can hinder the placement of an LV lead in the target vessel, leading to poor CRT response. Objective: To report experience with snare-assisted LV lead delivery in CRT and compare outcomes with the conventional LV lead delivery. Methods: This is a single-center retrospective case–control study of CRT implants between 2016 and 2021. Snare-assisted lead delivery was performed in cases where conventional lead placement failed or when a preferred target vessel had anatomy amenable to the technique. Safety and outcomes were compared to conventional LV lead placement cases. Results: Among 180 CRT cases, 33 were snare-assisted, and 147 were conventional LV lead placements. Median follow-up was 924 days in the snare and 618.5 days in the control group. The lead placement was successful in 28/33 snare and 138/147 control cases. A mid-vessel segment was attained in 89.3% of snare and 72.5% of control cases(p =.03). The apical position was more frequently observed in the control group (26.8% vs. 7.1%, p =.03). All-cause mortality trended lower in the snare group (6.1%) compared to (17.1%) in the control group (p =.13). Conclusion: Snare-assisted LV lead delivery is a safe and effective technique that can be utilized for overcoming complex venous anatomy.