How do we manage the direction of a lumenless lead during placement?

Using a sheath, particularly one that is either fixed curve or deflectable, is a standard method for managing the direction of a lumenless lead during its placement. The design of a sheath allows for greater control and maneuverability, enabling the clinician to navigate the vascular anatomy effectively and position the lead accurately within the desired structure, such as the cardiac conduction system.

The fixed curve sheath provides a predefined angulation for targeting specific anatomical locations, while a deflectable sheath offers dynamic maneuverability that can adapt to the patient's unique vascular and cardiac anatomy. This adaptability is crucial for ensuring proper lead placement, which can significantly impact the success of the pacing therapy.

In contrast to using a sheath, alternatives such as balloon catheters, fluoroscopy, or manual guidance may not provide the same level of precision and control needed for effective placement of lumenless leads. Balloons are typically utilized for dilating vessels or areas where stenosis may be present, while fluoroscopy aids visualization rather than direct control during lead placement. Manual guidance, although possible, risks instability and variability in directionality without the support of a sheath.