Institution: | (1) Heart Center North Rhine Westphalia, Bad Oeynhausen, Germany;(2) Kerckhoff-Klinik, Cardiology, Bad Nauheim, Germany;(3) Policlinique Saint Henri, Nantes, France;(4) Clinique Bizet, Paris, France;(5) St. Lucas-Andreas Hospital, Amsterdam, The Netherlands;(6) Boston Scientific CRM Clinical Research, Brussels, Belgium;(7) Boston Scientific CRM Clinical Research, Paris, France;(8) Boston Scientific CRM Clinical Research, St. Paul, MN, USA;(9) Guidant Research EMEAC, Paris, France;(10) Guidant Research EMEAC, St. Paul, MN, USA;(11) Guidant Research EMEAC, Temecula, CA, USA;(12) Department of Cardiology, Heart Center Brandenburg in Bernau, Ladeburger Str. 17, D-16321 Bernau, Germany |
Abstract: | Introduction Failure to enter the coronary sinus (CS) with a guiding catheter and entering its tributaries remains challenging in left
ventricle (LV) pacing lead implants for cardiac resynchronization therapy (CRT). A dual telescoping catheter system (8F outer/6F
inner) is designed to provide the ability to adjust the catheter curve size, shape and/or reach to the patients’ anatomy avoiding
the need for catheter change.
Methods Five different designs for CS cannulation were randomly tested in 64 patients scheduled for CRT device implant.
Results In 33 consecutive patients three adaptable telescoping guiding catheter systems were tested per patient, the adaptable catheters
had higher overall cannulation success rates (68, 63 and 62%) compared to the fixed shape catheter (46%) and an greater cannulation
success rate when the CS location was not known (70, 53 and 72% vs 33% for the fixed shape). In a second group of 31 CRT patients
the two telescoping catheters had similar high levels of success (71–80%), with or without using the inner catheter.
Conclusions The telescopic system is adaptable to a wide range of anatomical variations in patients and can result in a higher CS cannulation
success rate due to its adjustability in the RA in search for the CS ostium. On top of this the inner catheter allows for
sub-selecting the CS tributaries. |