21. Cardiac Resynchronization Therapy: Implanting & Clinical Aspects: 21.2 A Novel Technique for Successful Coronary Sinus Cannulation and Left Ventricular Lead Positioning Using A Telescopic Dual-Catheter System

A new approach for coronary sinus cannulation and left ventricular lead positioning has been evaluated. This system consists of a guiding and an inner catheter as a telescopic way to cannulate the CS ostium and the target collateral vein (Dual-Catheter System-RAPIDO).

Forty-four consecutive patients with cardiomyopathy of any etiology (34 males, 72±9 yrs, QRS 169±23 ms, LV ejection fraction 27.6 ± 5.2%) underwent CRT (23 ICD) under standards indications.

Successful cannulation was achieved in 100% of cases. The mean time from insertion of the telescopic system into the subclavian vein to cannulation of the CS was 1.3±2.5 min. The mean LV lead positioning time, measured from CS cannulation to lead positioning in the final LV lead location, was 6.3±7 min. The total fluoroscopy and total procedural time were 16±11 min and 87±35 min, respectively. No major complications were observed.

This approach using a dual telescopic catheter system leads to a high percentage of success procedure rates. It is safe and feasible with a reduction of fluoroscopy time, procedural time and contrast agent volume. In our experience this system is superior in terms of time consuming and success rate compared to the traditional approach.