Left ventricular CRT-D lead implantation using the retrograde approach following lateral vein balloon angioplasty.

A 60-year-old female with heart failure with reduced left ventricle ejection fraction, implantable cardiac defibrillator and left bundle branch block was admitted to Department of Cardiology for cardiac resynchronization therapy defibrillator upgrade. Due to difficulties with advancement of left ventricular lead to lateral coronary vein, balloon angioplasty with use of retrograde approach via collateral branches and two CS sheaths positioning was performed. Final position of lead in lateral vein was achieved resulting with pacing threshold of 0.7 V/0.5 ms, impedance of 720 Ω and QRS of 130 ms.