Use of preshaped sheath to plan and facilitate cannulation of the coronary sinus for the implantation of cardiac resynchronization therapy devices: preshaped sheath for implantation of biventricular devices.
OBJECTIVE
The aim of the study is to describe a new technique for facilitating the implantation of cardiac resynchronization therapy (CRT) devices.


BACKGROUND
CRT, by simultaneous pacing of the right and left ventricles has proven to be a useful treatment for patients with advanced heart failure and left ventricular (LV) systolic dysfunction, who have concomitant LV dyssynchrony. One of the greatest challenges to the wide applications of this therapy has been the technical difficulty encountered with implantation of the left ventricular lead. This is mainly due to the varied anatomy of the coronary venous system, which is further complicated by distortion of the anatomy in patients with advanced heart failure.


METHODS
Details of the coronary venous anatomy are initially assessed by cannulating the coronary sinus (CS) using a specialized long preshaped sheath introduced from the femoral approach. Occlusive venography is performed in three views, and then the guide wire or the deflated balloon catheter is left in the CS for guidance. The most suitable equipment for the anatomy is chosen. Then, the operative site is prepped and the CS is approached from above.


RESULTS
From November 2003 until December 2004, we have used this approach on all patients presenting for CRT device implantation at Prince Sultan Cardiac Center (n = 25). The CS was cannulated using the preshaped catheter in less than 5 minutes in all cases. After delineation of the anatomy, successful CRT implantation was achieved in all patients. Mean procedure time for the implantation was 110 +/- 18 minutes. Uncomplicated minor CS dissection related to the use of the preshaped sheath was observed in 1 patient without consequences.


CONCLUSIONS
The use of preshaped sheath from the femoral approach facilitates planning the successful and safe implantation of CRT systems.
Al-Khadra
Ayman S
AS
Department of Adult Cardiology, Prince Sultan Cardiac Center, PO Box 7897, Riyadh 11159, Saudi Arabia. avnrt@hotmail.com
D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D003331:Coronary Vessels; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged