Implantation of a coronary sinus lead after stent dilatation of coronary vein stenosis

Biventricular pacing for the treatment of congestive heart failure has been shown to improve symptoms. To pace the left ventricle, the lead is implanted in the tributaries of the coronary sinus. However, 8% to 10% of the procedures result in failure to implant the coronary sinus leads. Implantation of a biventricular pacemaker was planned in a 57-year-old male patient with severe symptoms of heart failure and left bundle-branch block. Angiography revealed severe stenosis in the posterolateral branch, preventing the insertion of the lead and no other branch was available for the procedure. Stent dilatation of the coronary sinus stenosis was performed, which enabled easy insertion of the lead in the posterolateral branch, resulting in successful cardiac resynchronization.