Percutaneous access to the heart: Nontraditional approaches for the electrophysiologist

Percutaneous access to the heart: Nontraditional approaches for the electrophysiologist Adults with prior surgery for congenital heart disease present a growing challenge for the contemporary electrophysiologist. Unusual routes for venous access, difficulties with finding and cannulating the coronary veins, surgical baffles that preclude entry to certain cardiac chambers, and unusual manifestations for otherwise common arrhythmias form in large part the problems for successful management of adult congenital heart disease patients. In this segment of “Techniques, Technology, and Innovation” in the Journal of Cardiac Electrophysiology, Harake et al. present a lucid and practical approach to placing cardiac devices in patients with a prior bidirectional Glenn anastomosis. Despite our familiarity with subclavian and related vessels, entry to place leads in the cardiac chambers in patients exemplified by the Glenn procedure precluded entry via the superior vena cava (SVC) must be considered. Most centers would routinely utilize an open surgical and epicardial‐based approach for placing pacemakers in this patient population, but as Harake et al. point out, a readily available and well‐tolerated alternative is iliac venous access to successfully place not only pacemakers but potential resynchronization devices and some iterations of defibrillators without the need for open surgery.As with all great instructional manuals and documents, Harake et al. point out the need for attention to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiovascular Electrophysiology Wiley

Percutaneous access to the heart: Nontraditional approaches for the electrophysiologist