Coronary Sinus Dissection During Cardiac Resynchronisation Therapy Implantation

Abstract

Introduction: Implanting cardiac resynchronisation therapy (CRT) can be difficult. Manipulating catheters, leads and wires in the coronary sinus (CS) can result in dissection. Methods: From a series of 811 consecutive CRT implants, patients with CS dissection were analysed to evaluate predictive factors, outcomes and successful left ventricular (LV) lead implantation. Results: Thirteen patients were identified as having coronary sinus dissection; three with pericardial extravasation. Seven were initial implants, Five were upgrades and two were failed implants from other centres. Nine dissections occurred with the use of standard cannulation tools; four occurred with the use of stents, snares or advanced CRT methods. Patients with dissection were more likely to be older 71 ± 11 vs 67 ± 7 (p = ns) and obese 41% vs 31% (p = ns) than the population as a whole. Following dissection, the true lumen of the coronary sinus was cannulated in all 13 cases. Twelve of the 13 cases had a successful LV lead implantation at targeted LV site at the initial procedure and one patient at a later procedure. No patients had evidence of haemodynamic compromise. A transthoracic echo immediately following the procedure and at 24 h and three months did not show a significant pericardial effusion in any patient. A single patient had a significant pericardial pain delaying hospital discharge. Conclusions: CS dissection during CRT implantation is not common; acute and longer term complications are unlikely. Continued attempts at LV lead implantation can be safely and successfully undertaken at the initial procedure.