14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-119

Retrograde venography of the coronary sinus in candidates to left ventricular pacing

Roberto Neri, Antonio Silvio Cesario, PieroPalermo, DanielaBaragli, Maria Luisa d’Ettorre, Sergio Cavaglia*, GiancarloGambelli.
Division of Cardiology G.B. Grassi Hospital, Rome, *Medtronic Italia, Rome, Italy

Introduction

Simoultaneous right and left ventricular pacing has recently been introduced for the treatment of patients with severe heart failure and significant intraventricular and/or atrio-ventricular conduction defects^1-3. The goal of multisite pacing is to correct the electrical and mechanical asynchrony of the left heart, which is frequently present in dilated cardiomyopathy. Early results of uncontrolled studies in patients (pts) with refractory heart failure^3,4 have shown an improvement of the NYHA functional class after the implantation of an atrio-biventricular pacing system.

Preliminary hemodynamic studies, using thoracothomic leads implantation² have shown that biventricular pacing increase cardiac index and decrease pulmonary capillary pressure. These results have been confirmed using endocardial left and right ventricular pacing⁵.

The introduction of specifically designed coronary veins leads has made it possible to achieve left ventricular pacing via the coronary sinus (CS) with good success rate⁶.

However, due to variations of coronary veins anatomy, the placement of the pacing electrode into an appropriate CS branch is often difficult. The detailed knowledge of the anatomy of coronary veins may be helpful in anticipating potential anatomical obstacles and in selecting the appropriate CS branch. Although the anatomy of coronary sinus system has already been reported in an unselected patient population⁷, detailed informations of coronary veins anatomy in pts with dilated and failing hearts are lacking. The purpose of this study is to evaluate the angiographic anatomy of CS vein system in potential candidates to biventricular pacing using balloon occlusion retrograde venography.