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Angiographic findings and treatment of coronary sinus spasm during left ventricular lead placement: A case report

Tomo Komaki1, Yuuka Shibata1, Kaori Mine1

  • 1Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.

Journal of Cardiology Cases
|October 31, 2022
PubMed

Insights

Coronary sinus spasm is a rare complication during left ventricular lead placement for cardiac resynchronization therapy. Prompt recognition and treatment with nitrates can resolve the spasm, enabling successful lead implantation.

Area of Science:

  • Cardiology
  • Interventional Electrophysiology

Background:

  • Cardiac resynchronization therapy (CRT) with an implantable defibrillator is crucial for patients with heart failure and conduction abnormalities.
  • Left ventricular (LV) lead placement via the coronary sinus (CS) is a key component of CRT.

Observation:

  • During LV lead placement, a 71-year-old man experienced significant resistance during deep CS cannulation.
  • CS venography revealed a complete occlusion, which spontaneously resolved after several minutes, indicating venospasm.

Findings:

  • Coronary sinus spasm presented as an abrupt occlusion on venography.
  • Intravenous isosorbide dinitrate administration and a brief waiting period without catheter manipulation successfully resolved the spasm.
  • Successful LV lead placement was achieved after spasm resolution.

Implications:

  • Coronary sinus spasm, though rare, is a potential complication during LV lead placement.
  • Awareness of CS spasm's angiographic findings and effective management strategies is crucial for electrophysiologists.
  • Timely recognition and treatment can prevent procedural delays and ensure successful CRT device implantation.

Keywords:
Cardiac resynchronization therapyCoronary sinus spasmCoronary sinus venography

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