A Case-based Approach To Pacemakers, — Icds, And ...

This required a third lead, a delicate maneuver through the coronary sinus to reach the outer wall of the left ventricle. It was the most technical procedure in Elias’s repertoire. When the device was finally programmed, it forced both sides of Julian's heart to contract simultaneously.

Elias remembered the procedure—the small incision below the collarbone, the threading of the leads through the subclavian vein. He had placed one lead in the right atrium and another in the right ventricle. When he turned the device on, the jagged, chaotic lines on the monitor smoothed into a rhythmic, artificial grace. A Case-Based Approach to Pacemakers, ICDs, and ...

The final case was the most complex. Julian Vane suffered from end-stage Heart Failure. His heart was enlarged and "dyssynchronous"—the left and right sides were beating out of step, like two rowers in a boat pulling at different times. He couldn't walk ten feet without gasping for air. This required a third lead, a delicate maneuver