{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:14Z","timestamp":1753876274739,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T00:00:00Z","timestamp":1677542400000},"content-version":"vor","delay-in-days":48,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Guidelines support upgrade to cardiac resynchronization therapy (CRT) through His-bundle pacing (HBP) in pacing-induced cardiomyopathy and moderate left ventricular systolic dysfunction (LVSD). Lead-related venous occlusion can represent an obstacle to upgrade procedures. We describe a technique to overcome venous occlusion through direct puncture of a collateral vein facilitating upgrade to HBP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>An 84-year-old man with a right ventricular (RV) pacemaker was referred with New York Heart Association (NYHA) Class III breathlessness secondary to moderate LVSD (left ventricular ejection fraction [LVEF] 45%). Device interrogation revealed 100% RV pacing and AV-dyssynchrony. To optimize atrioventricular (AV) and interventricular (VV) synchrony a CRT upgrade with HBP was planned. Venography revealed an occluded left subclavian vein which was probed in a retrograde manner using a 6F MPA catheter from right femoral venous access. We were able to direct the catheter distal to the left brachio-cephalic vein and define the occlusion using contrast. A collateral branch was identified, a J-wire was left in this branch and venous access was secured at this medial subclavian site using the Seldinger technique. A right atrial lead was deployed and 69\u2005cm ISI-1 His lead was deployed via a C315 sheath at the His-bundle. The resulted in non-selective HBP (Stim-QRS end 146\u2005ms). There were no procedural complications. Two months later both symptoms and LV function (LVEF 55%) improved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Lead-related venous occlusion occurs frequently and can be probed in a retrograde manner from femoral venous access using contrast, facilitating direct percutaneous puncture of collateral venous branches to allow upgrade to CRT via HBP.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad016","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T17:51:21Z","timestamp":1673459481000},"source":"Crossref","is-referenced-by-count":0,"title":["Retrograde venography to navigate an occluded subclavian vein to achieve cardiac resynchronization therapy upgrade via His bundle pacing: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-8248","authenticated-orcid":false,"given":"Christopher","family":"Pavitt","sequence":"first","affiliation":[{"name":"Sussex Cardiac Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust , Eastern Road, Brighton BN2 5BE , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishal","family":"Luther","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation Trust , 72 Du Cane Road, London W12 0HS , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lefroy","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation Trust , 72 Du Cane Road, London W12 0HS , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Tanner","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hammersmith Hospital, Imperial College NHS Foundation Trust , 72 Du Cane Road, London W12 0HS , UK"},{"name":"Cardiology Department, St Richard\u2019s Hospital, University Hospitals Sussex NHS Foundation Trust , Spitalfield Lane, Chichester PO19 6SE , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"2023030116254507700_","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ccep.2018.05.005","article-title":"Pacing-induced cardiomyopathy","volume":"10","author":"Merchant","year":"2018","journal-title":"Card Electrophysiol Clin"},{"key":"2023030116254507700_","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2023030116254507700_","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1093\/europace\/euu011","article-title":"His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover 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