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We report a successful LBBAP lead implantation using the sheath-in-sheath technique in a patient with RA enlargement and a TAP ring. The sheath-in-sheath technique can serve as a valuable alternative approach in patients with structural heart abnormalities in whom LBBAP lead placement with a standard delivery system is technically challenging.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368885 | PMC |
http://dx.doi.org/10.1002/joa3.70180 | DOI Listing |
JACC Case Rep
August 2025
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Objective: We illustrate transcatheter left atrial appendage closure under local anesthesia with intracardiac echocardiography guidance for a complex patient with repaired tetralogy of Fallot at high risk for general anesthesia, with preprocedural cardiac computed tomography (CT) support.
Key Steps: 1) CT imaging and analysis; 2) vascular access with use of sheath-in-sheath technique; 3) transseptal puncture with VersaCross system; and 4) deployment of Watchman device in CT-planned projection.
Potential Pitfalls: 1) Selection of appropriate preprocedural imaging modality; 2) use of sheath-in-sheath technique to avoid kinking of catheters; 3) use of VersaCross transseptal system to avoid repeat punctures, unnecessary exchanges, and risk of injury; and 4) avoidance of general anesthesia to reduce risk in a high-risk patient.
We report a successful LBBAP lead implantation using the sheath-in-sheath technique in a patient with RA enlargement and a TAP ring. The sheath-in-sheath technique can serve as a valuable alternative approach in patients with structural heart abnormalities in whom LBBAP lead placement with a standard delivery system is technically challenging.
View Article and Find Full Text PDFClin Case Rep
August 2024
Department of Cardiology, Asia Medical Group, Sapporo Heart Center Sapporo Cardiovascular Clinic Sapporo Japan.
J Innov Card Rhythm Manag
May 2024
Heart Rhythm Services, Division of Cardiovascular Diseases, St. Rita's Medical Center, Lima, OH, USA.
As the prevalence of leadless pacemaker systems increases, identifying various methodologies for retrieval of these devices in certain instances becomes even more paramount. We describe a case demonstrating the utility of a coronary guide catheter as part of an improvised sheath-in-sheath technique for the challenging retrieval of a Micra™ leadless pacing system (Medtronic, Minneapolis, MN, USA).
View Article and Find Full Text PDF