title: Importance of anterograde visualization of the coronary venous network by selective left coronary angiography prior to resynchronization.
abstract: BACKGROUND
  Understanding of coronary anatomy is essential to the advancement of cardiac resynchronization therapy (CRT) techniques. We determined whether the difficulties associated with catheterization of the coronary sinus (CS) and its lateral branches could be overcome by a preliminary angiographical study of the coronary venous system carried out during a pre-operative coronary angiography with examination of venous return.
  
  
  RESULTS
  All patients were scheduled for an exploratory angiography procedure and indicated for CRT. Group A patients were implanted with a CRT device after a right arterial angiographical procedure while group B patients had a selective left angiogram including examination of venous return. Data analyzed in group B were: position of CS ostium, number and distribution of lateral branches, and ability to preselect a marginal vein suitable for catheterization. Subsequent device implantation was guided by these parameters. A total of 96 and 89 patients were included in groups A and B, respectively. Implantation success rates were not different (98% and 100%, respectively), but CS catheterization time was reduced in group B (6 minutes vs 4 minutes; P < 10(-6)) as well as total time required to position the left ventricular lead (25 minutes vs 15 minutes; P < 10(-6)), fluoroscopy exposure (7 minutes vs 5 minutes; P < 10(-6)), and volume of contrast medium required (45 mL vs 15 mL; P < 10(-6)).
  
  
  CONCLUSIONS
  A coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient-specific preselection of appropriate tools for the procedure.
authors.affiliation: Department of Cardiology, CH F Mitterand, Pau Université Cedex, France. N.Delarche@wanadoo.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delarche
authors.forename: Hugues
authors.initials: H
authors.lastname: Bader
authors.forename: Raphael
authors.initials: R
authors.lastname: Lasserre
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Stephan
authors.initials: S
authors.lastname: Debeugny
authors.forename: Maializ
authors.initials: M
authors.lastname: Denard
authors.forename: Gérard
authors.initials: G
authors.lastname: Estrade
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial