The Jurdham Procedure: Endocardial Left Ventricular Lead Insertion Via a Femoral Transseptal Sheath for Cardiac Resynchronization Therapy Pectoral Device Implantation

Background: Endocardial stimulation of the left ventricle for cardiac resynchronization therapy is a growing field of investigation. Despite the excellent results and absence of significant complications demonstrated thus far in the literature, the lack of a simple, straightforward, and standard technique limits its widespread utilization.

Objective: To assess the feasibility, safety, simplicity, and complications of a technique for inserting the left ventricle lead through a femoral transseptal sheath to the pectoral implant site, termed "the Jurdham procedure."

Methods: We performed the Jurdham procedure in 10 patients (8 men; 60.5 ± 1.8 years) in whom a coronary sinus lead implant had failed. A snared 85-cm standard active fixation endocardial pacing lead was implanted on the left ventricle endocardium through a femoral transseptal sheath with subsequent mobilization of the proximal end of the lead to the prepectoral area via the snare.

Results: Successful implant was achieved in all 10 patients without complications, with excellent acute and chronic pacing parameters. All patients remained on chronic oral anticoagulation therapy without thromboembolic or bleeding complications. No late complications have occurred. All patients have improved at least 1 New York Heart Association functional class and have remained clinically stable during the follow-up term.

Conclusion: The Jurdham procedure is a reliable, technically easy technique to achieve cardiac resynchronization therapy via the endocardial approach. In our initial experience, there has been an excellent clinical response without significant complications during short-term follow-up. Additional investigation is needed to define the precise indications and limitations of this procedure.