title: A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants.
abstract: 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.
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: Loredana
authors.initials: L
authors.lastname: Messano
authors.forename: Matteo
authors.initials: M
authors.lastname: Santamaria
authors.forename: Quintino
authors.initials: Q
authors.lastname: Parisi
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Tommaso
authors.initials: T
authors.lastname: Sanna
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Narducci
authors.forename: Tiziana
authors.initials: T
authors.lastname: Chiriaco
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Paolo
authors.initials: P
authors.lastname: Zecchi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: 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*
chemical_list: D003287:Contrast Media