Abstract 19227: Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy is Facilitated by Three Dimensional Rotational Venography of the Coronary Sinus Tree
Cardiac resynchronization therapy (CRT) requires optimal visualization of the coronary sinus (CS), its tributaries and their threedimensional localization for successfull lead placement. Preoperative knowledge of the CS anatomy facilitates catheter-based intubation of the CS, target vein and lead selection and reduces the need for fluoroscopy, contrast medium and overall procedure time. 3-dimensional rotational angiography (3DRA) provides a new means of multiangle imaging of the CS tree that can be applied preoperatively in the cath lab. Our study aims to investigate the feasibility of preoperative rotational CS venography and its implications on CRT implantation procedures. For this purpose, CS-visualization for CRT implantation was done either conventionally with retrograde CS-venography and standard fluoroscopic views (SFV, n = 30), or with antegrade CS-imaging via contrast medium injection (15 ml) into the left coronary artery using 3DRA in the venous phase of contrast flow (3DRA, n = 30). 3DRA successfully identified the posterior and lateral veins in 92%, and allowed target vein visualization in 86%. Additional retrograde venography was necessary in 4 pts (14%). Fluoroscopy time for stable CS intubation with a guiding catheter was significantly reduced in 3DRA (3,4 ± 2, 9 min) as compared to SFV (7,8 ± 3,2 min, p < 0.05). Also, contrast medium application for CS intubation was less in the 3DRA group (18 ± 4 ml) in comparison to SFV (26 ± 12 ml, p < 0.05). Due to better imaging of the site of target vein takeoff, its angulation and course in 3DRA, the time for CS lead placement after guiding catheter intubation was 8,9 ± 5,5 min in the 3DRA group versus 14.7 ± 7,4 min in SFV pts (p < 0,05). Consequently, total fluoroscopy time (- 12,1 min), volume of contrast medium (- 29, 5 ml) and overall procedure time (- 32,8 min) was significantly lower in 3DRA- than SFV-pts (p < 0.05). In summary, preoperative 3DRA offers reliable multiangle visualization of the CS anatomy and facilitates successfull CRT lead implantation.
- © 2010 by American Heart Association, Inc.