Coronary Sinus Reducer Implantation in a Patient With Pre-Existing Left Ventricular Lead

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BACKGROUND: Coronary sinus reducer (CSR) implantation is a novel therapeutic modality for patients with refractory angina and no targets for invasive coronary intervention. With expanding indications for cardiac resynchronization therapy, data related to safety of CSR implantation in patients with prior left ventricular (LV) lead are scarce. CASE SUMMARY: We report the successful implant of a CSR device in the coronary sinus of a 79-year-old patient with a pre-existing LV lead with ischemic cardiomyopathy referred for symptoms of refractory angina. DISCUSSION: LV lead failure can lead to the reemergence of symptoms of heart failure warranting lead removal and reimplantation. Trapping of the LV lead between the CSR stent and the coronary sinus may make future lead extractions challenging. TAKE-HOME MESSAGE: CSR implantation in the presence of LV lead is feasible; however, long-term data are required regarding whether the presence of the LV lead effects CSR endothelialization or subsequent device failure rate.

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