Tiger Diagnostic Catheter-Facilitated coronary sinus cannulation (Mother-in child system) and implantation of Left ventricular lead during cardiac resynchronization therapy system

Cardiac resynchronization therapy (CRT) device implantation is hampered by difficult placement of the left ventricular (LV) lead. Here we report a case of 68-year old male who presented with heart failure having New York Heart Association (NYHA) class III. He was hospitalized with ventricular tachycardia which was restored to normal rhythm by cardioversion. Electrocardiogram revealed normal sinus rhythm, and complete left bundle branch block (LBBB) with prolonged QRS complex duration (198ms). Echocardiogram showed dilated left atrium, and ventricle with severe left ventricular (LV) systolic dysfunction (ejection fraction= 35%). Coronary sinus cannulation was failed with conventional technique, steerable electrophysiology (EP) catheters, and other guiding catheters. CS was successfully cannulated with the help of Tiger Diagnostic Catheter (Terumo, Japan) using mother-in child system and LV lead was implanted into desired territory, thus completing the procedure