title: A randomized comparison of alternative techniques to achieve coronary sinus cannulation during biventricular implantation procedures.
abstract: BACKGROUND
  Biventricular pacing system implantation is a time-consuming and challenging procedure. A critical step in biventricular pacemaker implantation is coronary sinus (CS) cannulation. CS cannulation can be achieved either using dedicated guiding catheters (guiding catheter alone positioning strategy, GCA) or with the aid of an electrophysiology catheter advanced inside the guiding catheter (electrophysiology catheter aided positioning strategy, EPA).
  
  
  OBJECTIVE
  To evaluate whether the EPA technique is useful for reducing CS cannulation time compared to a conventional GCA technique.
  
  
  METHODS
  Thirty-four consecutive patients were randomly assigned to the GCA (18 patients) or EPA (16 patients) CS cannulation strategy.
  
  
  RESULTS
  Time to successful catheterization of CS was 5.0 +/- 2.4 min in the EPA group versus 10.1 +/- 5.4 min in the GCA group p = 0.004. Fluoroscopy time was 4.6 +/- 2.3 min in the EPA group versus 9.2 +/- 4.9 min in the GCA group p = 0.004. Total contrast dye volume to search and engage the CS ostium was 0.0 ml in the EPA group versus 14.3 +/- 3.4 ml in the GCA group p < 0.001.
  
  
  CONCLUSIONS
  Cannulation of CS with the adjunct of an electrophysiology catheter to dedicated delivery systems significantly reduces procedural time, fluoroscopy time and contrast dye volume compared to a conventional strategy.
authors.affiliation: Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. giusepdemartino@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Martino
authors.forename: Tommaso
authors.initials: T
authors.lastname: Sanna
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Loredana
authors.initials: L
authors.lastname: Messano
authors.forename: Carolina
authors.initials: C
authors.lastname: Ierardi
authors.forename: Daniele
authors.initials: D
authors.lastname: Gabrielli
authors.forename: Quintino
authors.initials: Q
authors.lastname: Parisi
authors.forename: Paolo
authors.initials: P
authors.lastname: Zecchi
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D002304:Cardiac Pacing, Artificial; D002404:Catheterization / Q000295:instrumentation; D002408:Catheters, Indwelling; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015995:Prevalence; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy