Figure 2.

The Orthodromic Snare Technique. (A) Venography showed that the proximal portion of the target branch (anterolateral vein) was tortuous with a connecting vein present between anterolateral and posterolateral veins. (B) A 0.014″ guidewire was advanced into the anterolateral vein and back into the CS ostium via the connecting vein (white arrow). (C) LV lead insertion into the target branch was unsuccessful due to its tortuous course. (D) The distal end of the guidewire was snared at the right atrium. (E) The distal end of the guidewire was snared out of the sheath. The LV lead was inserted via the guidewire proximal end (yellow arrow), and they traveled in the same direction. (F) Successful LV lead implantation into the anterolateral vein. CS, coronary sinus; LV, left ventricle; RV, right ventricle.