The buddy wire technique: accessing lateral coronary veins while maintaining coronary sinus position
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Updated: Aug 15, 2026
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Christian Perzanowski1, F Roosevelt Gilliam
1Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA.
Insights
A new technique allows for secure coronary sinus lead placement in challenging lateral or posterolateral veins. This method improves access near the coronary sinus os, optimizing cardiac resynchronization therapy.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Electrophysiology
Background:
- Optimal coronary sinus lead (CSL) placement is crucial for cardiac resynchronization therapy (CRT).
- Lateral or posterolateral cardiac veins are preferred for CSL deployment.
- Challenges exist in accessing suitable veins due to anatomical variations or operator limitations.
Observation:
- Coronary sinus venography frequently reveals a lack of accessible lateral veins for CSL implantation.
- Deployment in the anterior cardiac vein offers limited CRT benefits.
- Posterolateral vessels or the middle cardiac vein (MCV) near the coronary sinus (CS) os are often ideal but difficult to access.
Findings:
- Accessing vessels near the CS os typically requires disengaging the CS guide, risking loss of access.
- A novel technique is presented to facilitate access to these challenging vessels.
- This technique enables secure cannulation of cardiac veins near the CS os while maintaining stability within the main CS.
Implications:
- This technique may improve the success rate of CRT lead implantation.
- Enhanced CSL positioning could lead to better patient outcomes in CRT.
- The described method offers a solution for operators facing difficulties in CS lead deployment.
Abstract:
There is compelling data to place the coronary sinus lead (CSL) in a lateral or posterolateral tributary. Coronary sinus venography often demonstrates the absence of easily accessible lateral veins or those with sufficient size to accommodate the CSL. The operator may choose to deploy the CSL in the anterior vein but publications and experience highlight the lack of resynchronization benefit when the CSL is deployed in this location. There is often a posterolateral vessel or the middle cardiac vein (MCV) originating from near the coronary sinus (CS) os. These vessels require the operator to pull the CS guide essentially out of the CS to allow successful access. Cannulation of the coronary sinus (CS) is often challenging, and the risk of losing access to the CS may dissuade the implanter from attempting access to a vessel near the CS os. We describe a technique to access vessels near the CS os while maintaining secure position in the main body of the CS.
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