Coronary sinus cannulation with a steerable catheter during biventricular device implantation

Objectives. To determine whether a steerable catheter with electrogram guidance (CS-assist group) could facilitate access to the coronary sinus (CS) during cardiac resynchronization therapy (CRT) implantation. Design. Consecutive patients who underwent CRT implantation were recruited prospectively into the CS-assist group (n = 81) and compared with those using conventional techniques without an electrogram guidance (conventional group, n = 101). Results. The CS cannulation success rate was clearly greater in the CS-assist group (100%) than that in the conventional group (95%, p < 0.05), with significantly shorter mean procedure time (52.6 +/- 20.6 min vs. 73.2 +/- 40.9 min, p < 0.01) and fluoroscopy time (3.6 +/- 3.2 min vs. 14.2 +/- 20.4 min, p < 0.01). In the five CS cannulation failure cases, mean procedure time (144.0 +/- 37.0 min) and fluoroscopy time (57.8 +/- 24.8 min) were significantly longer than those in the other patients (61.2 +/- 32.3 and 8.2 +/- 13.6 min, respectively, n = 177, both p < 0.01). Conclusions. Using the steerable catheter with real-time electrogram guidance, location of and access to the CS is more rapid and successful, which may improve the success of the CRT implantation and may give significant time savings.