Introduction A 54-year-old man with superior vena cava occlusion was referred to our institution for an upgrade to cardiac resynchronization therapy defibrillator. Methods and results Right ventricular lead extraction with modified venoplasty, rocket-shape crossing technique (RCT), was performed. In RCT, the integration of the inflated balloon, halfway inside the laser sheath, and the laser sheath are advanced through the occlusion like a “rocket-shape crossing”. Conclusion Modified venoplasty can be useful during device upgrades in patients with venous occlusion.

Introduction: We analyzed the influence of the QRS duration (QRSd) to left ventricle (LV) end-diastolic volume (LVEDV) ratio on the clinical outcome of cardiac resynchronization therapy (CRT) in HF patients with small body size and New York Heart Association (NYHA) classification III/IV. Methods and Results We enrolled 114 patients with advanced heart failure (NYHA class III/IV, and LV ejection fraction > 35%) who received a CRT device, including those with left bundle branch block (LBBB) and QRSd ≥ 120 ms (n = 60), non-LBBB and QRSd ≥ 150 ms (n = 30), and non-LBBB and QRSd of 120-149 ms (n = 24). Over a mean follow-up period of 65 ± 58 months, the incidence of the primary endpoint, a composite of all-cause death and hospitalization for heart failure, showed no significant intergroup difference (43.3% vs. 50.0% vs. 37.5%, respectively, p = 0.72). Similarly, among 104 patients with QRSd/LVEDV ≥ 0.67 (n = 54) and QRSd/LVEDV < 0.67 (n = 52), no significant differences were observed in the incidence of the primary endpoint (35.1% vs. 51.9%, p = 0.49). Nevertheless, patients with QRSd/LVEDV ≥ 0.67 showed better survival than those with QRSd/LVEDV < 0.67 (14.8% vs. 34.6%, p = 0.0024). Conclusion: Advanced HF patients with a higher QRSd/LVEDV ratio showed better survival in this small-body–size population. Thus, the risk is concentrated among those with a larger QRSd, and patients with a relatively smaller left ventricular size appeared to benefit from CRT.