Novel tips for engaging the coronary sinus guided by right ventricular lead.
OBJECTIVE
This study investigated the relationship between the ostia of the coronary sinus (CS) and the tricuspid annulus (TA) for CS cannulation using a right ventricular (RV) lead, which could map out the TA by forming a curve when placed at the apex or low septum.


RESULTS
Seventy patients (45 males, 67 ± 12 years) who were admitted for CRT device implant were included in the evaluation of the relationship between the CS ostia and TA. An electrophysiological (EP) mapping catheter was used to probe the CS. The ostium was shown by the CS venography at the left anterior oblique (LAO) 20° and caudal 20°. Local electrograms were collected with CS catheters in the CS or RV. Transthoracic echocardiography was evaluated before each procedure. All CS ostia were located within 3.75 cm around the tip of TA. Sixty-two subjects (Group I, 89%) had CS ostia located under the TA. Eight patients (Group II) with CS ostia over the TA revealed larger left ventricular (LV) size and a smaller ratio of left atrium (LA)/LV size. LV enlargement predicted the presence of CS ostia over the TA. Typical CS electrograms were used to further confirm if the EP catheter was in the CS in all the subjects.


CONCLUSIONS
Use of the RV lead revealed that the CS ostia had a close relationship with the TA.
Division of Cardiology, Department of Medicine, Department of Health of Executive Yuan,  Fong Yuan Hospital.
Chien-Ming
CM
Cheng
Jin-Long
JL
Huang
Tsu-Juey
TJ
Wu
Chieh-Shou
CS
Su
Hsi-Yen
HY
Pai
Mau-Fang
MF
Liao
Chih-Tai
CT
Ting
Shih-Ann
SA
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018780:Body Surface Potential Mapping / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000601:surgery; D004452:Echocardiography / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods