34
Implant Procedure
Table 5. Reasons for Abandonment and/or Crossover to
Alternative CPP Approach During Implantation
CPP type
Anatomical/technical
considerations Function considerations
CRT with
BiV pacing
• Venous inaccessibility
(subclavian, innominate vein,
or superior vena cava [SVC]
occlusion)
• CS inaccessibility (occlusion,
dissection, perforation,
Thebesian valve)
• Coronary vein inaccessibility
(small, angulated, or tortuous
vein branches)
• Suboptimal vein location
(non-lateral vein, anterior
interventricular vein)
• Persistent SVC
• Poor lead stability, prone to
dislodgment
• Capture threshold
>5 V/1 ms in all available
pacing configurations
• Diaphragmatic stimulation
in all available pacing
configurations
HBP • Unable to identify HB location
• Lead instability
• Capture threshold >5 V/1 ms
• R sensing <2 mV
• Atrial oversensing
• Potential need for a backup
lead
LBBAP • Unable to penetrate the
septum to reach LBB (LV
subendocardium)
• Lead instability
• Risk of septal perforation
• Inability to correct LBB block
