Abstract 3240: High Speed Rotational Coronary Venous Angiography Improves Delineation of Coronary Venous Anatomy during Cardiac Resynchronization Therapy

Abstract

Background: The implantation of the left ventricular lead for biventricular devices can be challenging due to anatomic variation in the branching pattern of the coronary sinus (CS). Standard coronary venous (CV) angiography (SCVA) provides a static, fixed projection of the CV tree. Typically multiple contrast injections are obtained to gain a better understanding of vessels overlap and foreshortening. But, even in this situation, the site of side branch takeoff, its angulation and course cannot be reliably predicted - particularly in the presence of complex branching patterns. High-speed rotational CV angiography (RCVA) permits a dynamic, multi angle visualization of the CV anatomy. Objective: To compare RCVA with SCVA during cardiac resynchronization therapy. Methods: Digitally acquired RCVA from 10 patients were analyzed. RCVA uses a rapid isocentric rotation over a 180° arc, RAO 54° to LAO 54° in 4 sec, acquiring 121 frames /angiogram with a single injection of 20 ml of contrast (Infinix, Toshiba). The CV anatomy assessed by RCVA was compared with 2 static perpendicular views: RAO 45° and LAO 45°. Results: Three-dimensional models of the venous tree were reconstructed (Figure ), and the rotational images were analyzed using a full range of gantry angles, providing the operator with considerably more information about the CV anatomy than SCVA images. Conclusion: RCVA provides a better understanding of the CV anatomy and the special relationship of its branches. The SCVA view which optimally displayed the appropriate CS branch for left ventricular lead implantation was often different from the conventional RAO and LAO views.