Antegrade visualisation of the coronary sinus for left ventricular pacing

Failure to achieve left ventricular pacing remains one of the obstacles to cardiac resynchronisation therapy.

A new technique for the placement of left ventricular pacing leads in the tributaries of the coronary sinus is described. Antegrade visualisation of the coronary sinus is accomplished by selective coronary angiography and a hydrophilic 0.032" wire is advanced along the coronary sinus. This facilitates advancement of a coronary sinus sheath over a multipurpose diagnostic catheter. A hydrophilic angioplasty wire is then utilised for negotiation of the inferior left ventricular vein and successful placement of the left ventricular pacing lead.

In 5 patients in whom cannulation attempts were unsuccessful despite prolonged fluoroscopy time (39.85 +/- 9.6 min), the new technique resulted in successful placement of the left ventricular pacing lead within an average fluoroscopy time of 6.5 +/- 2.1 min.

Antegrade visualisation of the coronary sinus via selective coronary angiography and the use of a hydrophilic angiography wire may facilitate successful implantation of a left ventricular pacing lead in difficult cases.