title: Feasibility and procedure-related patient discomfort of peripheral venous access for coronary sinus cannulation during electrophysiology procedures.
abstract: BACKGROUND
  Placement of an electrode catheter in the coronary sinus (CS) through the jugular or subclavian vein, as part of electrophysiology (EP) procedures, increases patient discomfort and the possibility of adverse events. We studied the hypothesis that peripheral venous access for CS cannulation, as part of EP procedures, is feasible and can reduce patient discomfort, eliminating central venous access-associated risks.
  
  
  METHODS
  Consecutive patients submitted to EP procedures were randomly assigned to peripheral or central venous access for CS cannulation. If after 30 min from initial needle insertion the CS was still not catheterized, the attempt was considered unsuccessful. Patient level of discomfort was assessed with a visual analog scale (VAS).
  
  
  RESULTS
  Success rate was 90% in the peripheral versus 95% in the central venous access group (p = 1.00). No complications related to venous access were observed in the peripheral venous access group, whereas one case of pneumothorax and one case of extensive hematoma in the anterior cervical area were recorded in the central venous access group. Patients submitted to central vein catheterization reported higher VAS scores, 46.8 ± 16.3 versus 36.8 ± 12.9 (p = 0.04). No significant difference was observed in fluoroscopy time needed for CS cannulation (51.1 ± 9.2 s versus 51.4 ± 7.9 s; p = 0.71) between the two groups.
  
  
  CONCLUSIONS
  This small, randomized study indicates that peripheral venous access for CS catheter placement during EP procedures is feasible, with equivalent success rate to the central venous access approach, and associated with lower levels of self-reported patient discomfort.
authors: Department of Cardiology, Athens General Hospital G. Gennimatas, 154 Mesogeion Ave., 11527, Athens, Greece.
authors: Spyridon
authors: S
authors: Deftereos
authors: Georgios
authors: G
authors: Giannopoulos
authors: Charalambos
authors: C
authors: Kossyvakis
authors: Konstantinos
authors: K
authors: Raisakis
authors: Vasiliki
authors: V
authors: Panagopoulou
authors: Andreas
authors: A
authors: Kaoukis
authors: Konstantinos
authors: K
authors: Doudoumis
authors: Vlasios
authors: V
authors: Pyrgakis
authors: Christodoulos
authors: C
authors: Stefanadis
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects*; D054326:Coronary Sinus; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome