Fluoroless coronary sinus cannulation using a BeeAT catheter and the CARTO mapping system

Fluoroscopy-free ablation techniques have gained popularity in recent years. However, coronary sinus (CS) cannulation via the femoral approach remains technically challenging, particularly when using specialized catheters like the BeeAT™. To demonstrate a reproducible technique for fluoroscopy-free CS cannulation using the BeeAT catheter guided by CARTO® electroanatomical mapping and intracardiac echocardiography (ICE). Forty three patients undergoing atrial fibrillation ablation were enrolled. After 3D mapping of the right atrium and CS ostium identification via ICE, a femoral-type BeeAT catheter was inserted. Direct advancement or RA loop techniques were applied based on anatomy. CARTO settings were adjusted to allow impedance-based catheter visualization. Successful CS cannulation without fluoroscopy was achieved in all 43 cases. The direct technique succeeded in 36 cases, and the RA loop method was used in 7. No complications occurred. CONCLUSION: Fluoroscopy-free femoral CS cannulation with the BeeAT catheter is safe, feasible, and enhances procedural efficiency while avoiding radiation exposure.