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

Abstract

BACKGROUND. Atrium-biventricular cardiac stimulation, using transvenous pacing of the left ventricle (LV) through coronary sinus (CS) branches, is increasingly recognized as a valuable treatment to improve hemodynamic and clinical status in selected patients (pts) with severe heart failure. However, due to variations of coronary veins anatomy, the placement of the pacing electrode into an appropriate CS branch is often difficult. The purpose of this study is to evaluate the angiographic anatomy of CS vein system in potential candidates to biventricular pacing using a balloon occlusion retrograde venography.

METHODS. Balloon occlusion CS venograms were performed in 14 pts (age 65±15 yrs, 11 males, LVEF 22%±7%, QRS 139±2 ms, NYHA class III). Contrast was injected using a 6F balloon tipped catheter (Medtronic Inc., Minneapolis, MN, USA) Digital images were analyzed by two different observers for description oc:\www diameters of the CS and location, number, dimension, angulation and tortuosity of CS tributaries.

RESULTS. The average diameters of the proximal, mid and distal CS were the following: 9.7±2.4 mm; 6.3±1.4 mm; 5.5±0.9 mm. The mid cardiac vein (4.2±2.1 mm) draining in the CS close to the ostium was identified in 14/14 venograms (100%). The great cardiac vein (4.6±2.8 mm) draining into the distal CS was imaged in 13/14 (93%). A postero-lateral or a lateral vein (3.3±1.3 mm) draining into the CS or into the great cardiac vein was imaged in 14/14 (100%) of venograms. Postero-lateral veins showed an acute angle (<90°) at the junction with the draining vessels in 73% while lateral veins in 33% of cases.

CONCLUSIONS. In this study, CS tributaries with location and size suitable for the insertion of a permanent LV pacing lead could be always identified by retrograde venography. However, anatomical obstacles may prevent adequate lead placement unless material specifically designed to cross sharp angulations at the branching sites is available.

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