The use of telescoping guide catheters for coronary sinus cannulation and sub-selecting tributaries in left ventricular lead placement.
BACKGROUND
Failure to enter the coronary sinus (CS) with a guiding catheter and entering its tributaries remains challenging in left ventricle (LV) pacing lead implants for cardiac resynchronization therapy (CRT). A dual telescoping catheter system (8F outer/6F inner) is designed to provide the ability to adjust the catheter curve size, shape and/or reach to the patients' anatomy avoiding the need for catheter change.


METHODS
Five different designs for CS cannulation were randomly tested in 64 patients scheduled for CRT device implant.


RESULTS
In 33 consecutive patients three adaptable telescoping guiding catheter systems were tested per patient, the adaptable catheters had higher overall cannulation success rates (68, 63 and 62%) compared to the fixed shape catheter (46%) and an greater cannulation success rate when the CS location was not known (70, 53 and 72% vs 33% for the fixed shape). In a second group of 31 CRT patients the two telescoping catheters had similar high levels of success (71-80%), with or without using the inner catheter.


CONCLUSIONS
The telescopic system is adaptable to a wide range of anatomical variations in patients and can result in a higher CS cannulation success rate due to its adjustability in the RA in search for the CS ostium. On top of this the inner catheter allows for sub-selecting the CS tributaries.
Vogt
Jürgen
J
Heart Center North Rhine Westphalia, Bad Oeynhausen, Germany.
Schwarz
Torsten
T
Gras
Daniel
D
Sperzel
Johannes
J
Ritter
Philippe
P
de Voogt
Willem
W
Cebron
Jean-Pierre
JP
Seifert
Martin
M
Tockman
Bruce
B
Schubert
Bernd
B
Johnson
Eric
E
Doelger
Annette
A
Pochet
Thierry
T
Mouton
Elisabeth
E
Butter
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome