# Cardiac resynchronisation therapy in dextrocardia with situs Inversus totalis: a case report of strategies and outcomes in bipolar lead-based devices

## TL;DR

This case report describes a successful cardiac resynchronisation therapy in a patient with dextrocardia and heart failure using unconventional strategies.

## Contribution

The paper presents a novel approach to CRT-P and CSC in dextrocardia using a right-sided multipolar catheter and bipolar lead.

## Key findings

- Use of a right-sided multipolar catheter and bipolar lead improved QRS, EF, and symptoms in a dextrocardia patient.
- A right-sided CSC system allows implantation of CS leads with a left-sided device in dextrocardia.
- Bipolar CS lead is essential if the pre-existing bipolar RV lead is at risk of failure.

## Abstract

Cardiac resynchronisation therapy pacemaker (CRT-P) placement and coronary sinus cannulation (CSC) are notably challenging in dextrocardia (DXC).

A 56-year-old female with a diagnosis of DXC, sick sinus syndrome (SSS), paroxysmal atrial fibrillation (pAF), and heart failure reduced ejection fraction (HFrEF) presented for symptoms with exertion. Electrocardiogram (ECG) showed prolonged QRS necessitating CRT-P and CSC with right sided multipolar catheter and a bipolar lead. Postoperatively, there was improvement in QRS, EF, and symptoms.

CRT-P and CSC techniques in levocardia are well established. DXC requires unconventional CRT-P strategies. A right-sided multipolar catheter is valuable for CSC in DXC. This DXC case utilized a right-sided electrophysiology catheter and a bipolar coronary sinus (CS) lead. The use of these devices ensured that if the prior right ventricular (RV) ICD lead failed, a standard high S1 lead would be compatible with pacemaker headers.

A right-sided CSC system is useful for implanting CS leads with a left-sided device in DXC. While it comes at the expense of losing different pacing vectors, a bipolar CS lead is essential if there is a risk that the pre-existing bipolar RV lead will fail.