A technique for rapid transfemoral catheterization of the coronary sinus with multielectrode catheters

• Published in: Pacing and clinical electrophysiology Vol. 17; no. 11 Pt 1; p. 1737
• Main Authors: Kleman, J M, Pinski, S L, Sterba, R, Kidwell, G A, Trohman, R G
• Format: Journal Article
• Language: English
• Published: United States 01.11.1994
• Subjects: Adult; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiac Pacing, Artificial - methods; Coronary Angiography; Coronary Vessels; Electrodes; Femoral Vein; Fluoroscopy; Humans; Middle Aged; Radiography, Interventional; Veins
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.1994.tb03740.x

To minimize procedural and fluoroscopic times and avoid the risks of vascular injury and pneumothorax, some investigators have advocated elimination of routine placement of a coronary sinus (CS) catheter during electrophysiological procedures. We hypothesized that expedient and reproducible CS catheterization could be performed with minimal patient risk by utilizing a femoral vein approach. Fifty consecutive patients referred for radiofrequency ablative procedures underwent attempted CS catheterization using a 6-French steerable, quadripolar catheter via a femoral vein. Procedures were performed utilizing single-plane fluoroscopy without contrast angiographic aid by operators experienced in the technique. Successful catheterization was defined by the attainment, in < 15 minutes, of a stable catheter position with the distal electrode at or beyond the lateral margin of the heart. Successful catheterization of the CS was achieved in 47 (94%) patients. Selective pacing of the left atrium without patient discomfort was possible in all, eliminating the need for a right atrial pacing catheter. The median time to successful catheterization was 1.4 minutes (range 0.3-14.7). Only six patients required > 5 minutes. The median fluoroscopic time required was 1.2 minutes (range 0.3-12.7). No clinical variable was predictive of catheterization failure or time to successful catheterization. No complications were observed as a result of this technique. This prospective evaluation demonstrates that catheterization of the CS via a femoral vein approach is highly successful, expedient, and safe. The ability to selectively pace the left atrium may eliminate the requirement for a right atrial catheter.