Distal balloon occlusion allows epicardial lead placement in a tortuous branch of the great cardiac vein.

Cardiac resynchronization therapy (CRT) is a well established treatment modality in heart failure. Using standard techniques, placement of the left ventricular (LV) lead is usually successful; however LV lead placement failure remains a clinical problem. In the present report, the standard over-the-wire technique was not successful due to absence of the necessary support to place the lead into a tortuous vein.

The heterogeneous spectrum of the long QT syndrome.

The long QT syndrome affects predominantly younger people who demonstrate structurally normal hearts. The underlying defect in the long QT syndrome seems to be genetic mutations in the cardiac ionic channels responsible for generating action potentials. Genetic linkage mapping has identified six genes (designated LQT1-6) associated with the Romano-Ward syndrome; two of these genes (LQT1, LQT5) are associated with the Jervell and Lange-Nielsen syndrome.