A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants.
OBJECTIVE
Biventricular implantation procedures require contrast venography of the coronary sinus. The aim of our study was to evaluate the efficacy and safety of contrast venography obtained by direct manual contrast injection into the guiding catheter, compared with venography obtained after occlusion of the coronary sinus by a Swan-Ganz catheter.


METHODS
Eighty-three patients were randomly assigned to direct or occlusive venography technique. The primary endpoint was complication rate. The secondary endpoints were rate of and time required for an adequate venography, total dose of contrast medium and total procedure time.


RESULTS
Four dissections of the coronary sinus were observed with the occlusive venography technique group while no complications were observed with the direct venography technique group (p=0.04). Rate of adequate venography was similar in the two groups (p=NS). The time needed for coronary sinus venography and the total dose of contrast medium was significantly lower in the direct venography technique group compared with the alternative (p<0.0001 and p=0.003, respectively); the total procedure time was not significantly different between the two groups (p=NS).


CONCLUSIONS
The direct venography technique shows a significantly lower incidence of complications and should be considered to be the first line approach to coronary sinus venography during biventricular pacemaker implantation.
De Martino
Giuseppe
G
Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. giusepdemartino@libero.it
Messano
Loredana
L
Santamaria
Matteo
M
Parisi
Quintino
Q
Dello Russo
Antonio
A
Pelargonio
Gemma
G
Sanna
Tommaso
T
Narducci
Maria Lucia
ML
Chiriaco
Tiziana
T
Bellocci
Fulvio
F
Zecchi
Paolo
P
Crea
Filippo
F
D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010690:Phlebography / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
D003287:Contrast Media