title: Evaluation of femoral approach to coronary sinus catheterisation in electrophysiological and ablation procedures: Single centre experience.
abstract: BACKGROUND
  It has been reported that the cannulation of coronary sinus (CS) from the femoral approach is safer than the traditional subclavian approach but is associated with a lower rate of success. We aimed to test the validity of this claim.
  
  
  METHODS
  We evaluated retrospectively 1320 consecutive patients who underwent electrophysiological study (EPS) or ablation over a period of three years using a prospectively collected data. In cases requiring CS cannulation, it was attempted first from the femoral approach, switching if necessary to a subclavian approach when the femoral route failed.
  
  
  RESULTS
  Out of 1320 patients, 1165 (88.3%) required CS cannulation. The CS was successfully cannulated from the femoral approach in 99.3% of the cases in which it was attempted. One patient (0.09%) developed transient first degree atrioventricular block during an ablation procedure for AV nodal re-entrant tachycardia during cannulation of the CS that resolved within 3 min. Femoral access failed in 8 patients. In 4 of these cases, the procedure was concluded using CS cannulation via subclavian or jugular venous access. In the other 4 cases, the procedure was concluded successfully without CS cannulation, including an AF ablation in which CS cannulation proved impossible by either subclavian or femoral approach.
  
  
  CONCLUSIONS
  Femoral access can be used for CS cannulation with a high rate of procedural success in the vast majority of patients undergoing EPS and ablation. This approach is safe, and associated with a high rate of procedural success.
authors: Department of Cardiology, St. George's Hospital, London SW17 0QT, UK.
authors: Osama Abdel
authors: OA
authors: Atty
authors: Mohamed
authors: M
authors: Morsy
authors: Mark M
authors: MM
authors: Gallagher
keywords: Ablation; Coronary sinus; Electrophysiological study; Femoral
references: J Cardiovasc Electrophysiol. 2004 Mar;15(3):364-8
references: 15030429
references: J Interv Card Electrophysiol. 2002 Feb;6(1):71-5
references: 11839886
references: Circulation. 1995 Aug 1;92(3):436-41
references: 7634460
references: Indian Pacing Electrophysiol J. 2009 Jul 01;9(4):190-4
references: 19652728
references: Pacing Clin Electrophysiol. 2012 Oct;35(10):e291-2
references: 21091732
references: Indian Pacing Electrophysiol J. 2009 Jul 01;9(4):214-8
references: 19652733
references: Am J Cardiol. 1994 Jul 15;74(2):194-5
references: 8023792
references: Pacing Clin Electrophysiol. 1997 Nov;20(11):2755-64
references: 9392806
references: Europace. 2010 Aug;12(8):1193-4
references: 20353964
references: J Am Coll Cardiol. 1996 Mar 1;27(3):683-9
references: 8606282
references: Am Heart J. 1993 Nov;126(5):1216-9
references: 8237770
references: Am Heart J. 1994 May;127(5):1279-89
references: 8172057
references: Pacing Clin Electrophysiol. 2006 Jan;29(1):59-62
references: 16441719
references: Pacing Clin Electrophysiol. 2007 May;30(5):655-61
references: 17461876