Abstract
ObjectivesThe most challenging stage of cardiac resynchronization therapy (CRT) is coronary sinus cannulation (CS). The aim of this study was to compare coronary sinus cannulation techniques using electrophysiology catheters and coronary angiography catheters.MethodsIn this observational, retrospective and non-randomized study, 87 patients who were eligible for CRT device implantation were screened at Kahramanmaras Sutcu Imam University Hospital between March 2014 and March 2018. Seventy-two patients who met the inclusion criteria were enrolled in the study. The study population was divided into 2 groups: the first group consisted of 36 patients whose coronary sinuses were cannulated via electrophysiology (EP) catheters and the second group included 36 patients who received coronary angiography catheters for coronary sinus cannulation.ResultsThe two groups were similar in terms of the baseline characteristics of the patients. The total fluoroscopy time was less with cannulation using coronary angiography catheters. There were no differences between the two groups in terms of the amount of contrast material and the success of the operations.ConclusionsCoronary sinus catheterization using coronary angiography catheters significantly reduces fluoroscopy time in patients undergoing CRT.
Highlights
Cardiac resynchronization therapy (CRT) is recommended for patients with New York Heart Association (NYHA) Class II-IV symptoms, sinus rhythm, ejection fraction below 35%, and QRS duration !150 ms with morphology of left bundle branch block (LBBB) or non-LBBB, despite optimal medical therapy [1,2,3,4,5,6,7,8,9,10]
The study population was divided into 2 groups: the first group consisted of 36 patients whose coronary sinuses were cannulated via electrophysiology (EP) catheters and the second group included 36 patients who received coronary angiography catheters for coronary sinus cannulation
The total fluoroscopy time was less with cannulation using coronary angiography catheters
Summary
Cardiac resynchronization therapy (CRT) is recommended for patients with New York Heart Association (NYHA) Class II-IV symptoms, sinus rhythm, ejection fraction below 35%, and QRS duration !150 ms with morphology of left bundle branch block (LBBB) or non-LBBB, despite optimal medical therapy [1,2,3,4,5,6,7,8,9,10]. A left ventricular electrode is required for cardiac resynchronization therapy. It is usually placed via the coronary venous approach because the left ventricular electrode is less invasive. Despite the difficulties caused by the very variable anatomic structure of the coronary venous system, the success rate of left ventricular electrode implantation by means of cannulation of the coronary venous system is over 95% for experienced operators. The high rate of successful implantationis based on the following recommendations: good knowledge of the anatomy of the coronary venous system; having good visualization of the coronary venous system prior to and during the operation; and selecting the appropriate catheter and method for the appropriate coronary venous system cannulation based on the obtained images [13,14,15]
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