Before CRT -
1. AHA criteria for CRT indication -OK
2. Coronary Angiogram to rule out ischemic left ventricular dysfunction [CAG/SPECT/CMRI]
4. Coronary sinus angiogram in AP/RAO/LAO view to find suitable coronary vein tributary to place the left ventricular lead and antecubetal vein angiogram to rule anomalous venous system on the day
1.2
On the day of CRT
1. Keep coronary angiogram on screen of AP view
2. TPI in place through transfemoral
3. Scrub
4. Left infraclavicular local anaesthesia
5. Insert 3 short guide wire into IVC
6. Introduce 10Fr coronary sinus sheath
7. Repeat coronary sinus venogram to find suitable LV tributary if already documented view is not well profiled
LV lead insertion
7. Release one lead for introduce 10Fr sheath for left ventricular lead
8. Take JR -4Fr through 10Fr sheath and enter 10Fr sheath into coronary sinus
9. Advance 4Fr JR into the suitable left coronary sinus tributary [upper most and left most]
10. Remove terumo and JR keeping 10Fr in CS
11. Take reverse barman or 20ml syringe, do a coronary sinus venogram to find a suitable tributary
11. Load PTCA wire into LV lead and shape the tip of PTCA wire by giving double bend
12. Introduce LV lead into a pilable sheath then introduce same into 10Fr
13. Advance PTCA wire into suitable tributary
14. Move the LV lead into the above
15. Check threshold and if ok
16. Remove the pilable 10Fr and release its hub through sleeve of LV lead and lead screwing end
17. Secure LV lead into pocket using proline 2-0
18. Then introduce RV tin lead
19. Introduce RA appendage lead
20. Test each one for threshold, cough and deep inspiration and diaphragm contraction
21, Connect lead CRT device -top to RAA, MIDDLE-rv and bottom-lv, never forget to check lead connection proper also by their assigned number
22. Most of the procedure like PPI 23. Keep lead loops behind the PG by that you would not cut them on next visit
24. Keep the connecting side to left and top and the trade mark on PG should look anterior
25. Fix PG to both upper and lower part inside.
26. Complete like PPI
After CRT
-Immediate Chest X-Ray to rule out pneumothorax
-Watch for pocket hemotoma at earliest
-
1. AHA criteria for CRT indication -OK
2. Coronary Angiogram to rule out ischemic left ventricular dysfunction [CAG/SPECT/CMRI]
4. Coronary sinus angiogram in AP/RAO/LAO view to find suitable coronary vein tributary to place the left ventricular lead and antecubetal vein angiogram to rule anomalous venous system on the day
1.2
On the day of CRT
1. Keep coronary angiogram on screen of AP view
2. TPI in place through transfemoral
3. Scrub
4. Left infraclavicular local anaesthesia
5. Insert 3 short guide wire into IVC
6. Introduce 10Fr coronary sinus sheath
7. Repeat coronary sinus venogram to find suitable LV tributary if already documented view is not well profiled
LV lead insertion
7. Release one lead for introduce 10Fr sheath for left ventricular lead
8. Take JR -4Fr through 10Fr sheath and enter 10Fr sheath into coronary sinus
9. Advance 4Fr JR into the suitable left coronary sinus tributary [upper most and left most]
10. Remove terumo and JR keeping 10Fr in CS
11. Take reverse barman or 20ml syringe, do a coronary sinus venogram to find a suitable tributary
11. Load PTCA wire into LV lead and shape the tip of PTCA wire by giving double bend
12. Introduce LV lead into a pilable sheath then introduce same into 10Fr
13. Advance PTCA wire into suitable tributary
14. Move the LV lead into the above
15. Check threshold and if ok
16. Remove the pilable 10Fr and release its hub through sleeve of LV lead and lead screwing end
17. Secure LV lead into pocket using proline 2-0
18. Then introduce RV tin lead
19. Introduce RA appendage lead
20. Test each one for threshold, cough and deep inspiration and diaphragm contraction
21, Connect lead CRT device -top to RAA, MIDDLE-rv and bottom-lv, never forget to check lead connection proper also by their assigned number
22. Most of the procedure like PPI 23. Keep lead loops behind the PG by that you would not cut them on next visit
24. Keep the connecting side to left and top and the trade mark on PG should look anterior
25. Fix PG to both upper and lower part inside.
26. Complete like PPI
After CRT
-Immediate Chest X-Ray to rule out pneumothorax
-Watch for pocket hemotoma at earliest
-
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