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A randomized comparison of alternative techniques to achieve coronary sinus cannulation during biventricular
Giuseppe De Martino1, Tommaso Sanna, Antonio Dello Russo
1Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. giusepdemartino@libero.it
Insights
The electrophysiology catheter aided positioning strategy (EPA) significantly reduces coronary sinus (CS) cannulation time and contrast dye volume during biventricular pacing system implantation compared to the guiding catheter alone (GCA) method.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Biventricular pacing system implantation is complex and lengthy.
- Coronary sinus (CS) cannulation is a critical and challenging step.
- Two main strategies exist: guiding catheter alone (GCA) and electrophysiology catheter aided (EPA).
Purpose of the Study:
- To compare the efficacy of the EPA technique versus the GCA technique in reducing CS cannulation time.
- To evaluate procedural efficiency and resource utilization between the two methods.
Main Methods:
- A randomized study involving 34 patients undergoing biventricular pacing system implantation.
- Patients were assigned to either the GCA (18 patients) or EPA (16 patients) strategy for CS cannulation.
- Procedural times, fluoroscopy duration, and contrast dye volumes were recorded.
Main Results:
- The EPA group showed significantly shorter CS cannulation times (5.0 min vs. 10.1 min, p=0.004).
- EPA also resulted in reduced fluoroscopy time (4.6 min vs. 9.2 min, p=0.004).
- Contrast dye volume was negligible in the EPA group compared to the GCA group (0.0 ml vs. 14.3 ml, p<0.001).
Conclusions:
- The EPA technique significantly decreases procedural time for CS cannulation.
- EPA reduces fluoroscopy time and contrast dye usage compared to the conventional GCA strategy.
- Adjunct use of an electrophysiology catheter improves efficiency in biventricular pacing procedures.
Introduction:
Biventricular pacing system implantation is a time-consuming and challenging procedure. A critical step in biventricular pacemaker implantation is coronary sinus (CS) cannulation. CS cannulation can be achieved either using dedicated guiding catheters (guiding catheter alone positioning strategy, GCA) or with the aid of an electrophysiology catheter advanced inside the guiding catheter (electrophysiology catheter aided positioning strategy, EPA).
Aim Of The Study:
To evaluate whether the EPA technique is useful for reducing CS cannulation time compared to a conventional GCA technique.
Methods:
Thirty-four consecutive patients were randomly assigned to the GCA (18 patients) or EPA (16 patients) CS cannulation strategy.
Results:
Time to successful catheterization of CS was 5.0 +/- 2.4 min in the EPA group versus 10.1 +/- 5.4 min in the GCA group p = 0.004. Fluoroscopy time was 4.6 +/- 2.3 min in the EPA group versus 9.2 +/- 4.9 min in the GCA group p = 0.004. Total contrast dye volume to search and engage the CS ostium was 0.0 ml in the EPA group versus 14.3 +/- 3.4 ml in the GCA group p < 0.001.
Conclusions:
Cannulation of CS with the adjunct of an electrophysiology catheter to dedicated delivery systems significantly reduces procedural time, fluoroscopy time and contrast dye volume compared to a conventional strategy.
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