Cubital vein access provides a practical alternative to internal jugular vein access for coronary sinus catheter...

Area of Science:

• Cardiology
• Vascular Access
• Interventional Electrophysiology

Background:

• Transcatheter procedures targeting the coronary sinus (CS) often utilize the right internal jugular vein (RIJV) for electrode catheter insertion.
• RIJV access is associated with risks including pneumothorax and significant hematoma formation.
• Alternative venous access routes are being investigated to improve safety and feasibility.

Purpose of the Study:

• To compare the safety and feasibility of left cubital superficial vein catheterization versus the RIJV for CS access.
• To evaluate key procedural metrics and complication rates between the two access sites.

Main Methods:

• A prospective, nonrandomized study comparing left cubital vein (blind puncture) and RIJV (ultrasound-guided) access for CS catheter ablation.
• Data collected included sheath insertion success, CS cannulation success, procedure and fluoroscopy times, and complications.
• Patients undergoing catheter ablation between September 2021 and February 2023 were included.

Main Results:

• The RIJV group (58 patients) had a significantly higher sheath insertion success rate (100%) compared to the left cubital vein group (152 patients, 84.9%).
• Complications in the cubital vein group included failed blind punctures (20) and guidewire-induced venous injury (3). One arterial puncture occurred in the RIJV group.
• Following successful sheath insertion, CS cannulation success rates (97% vs 100%), procedure times, and fluoroscopy times were comparable between groups, with no serious complications.

Conclusions:

• The left cubital vein approach provides a practical and viable alternative for CS catheterization.
• While initial sheath insertion success is lower, the left cubital vein approach demonstrates comparable efficacy and safety for subsequent CS cannulation.