Coronary sinus anatomy variation with respect to left ventricle lead implantation in cardiac resynchronization therapy in Kashmiri population: An observational study

Background: Cardiac resynchronization therapy (CRT) has emerged as an important treatment modality for patients with heart failure and conduction abnormalities. The anatomical variations of the coronary sinus (CS) significantly impact the success of left ventricular (LV) lead placement during CRT implantation. Objective: The objective of the study was to investigate the prevalence and types of anatomical variations in the CS among patients eligible for CRT implantation in the Kashmiri population, evaluate gender-specific variations, and identify optimal veins and fluoroscopy quadrants for LV lead implantation. Materials and Methods: This observational descriptive study was conducted at the Department of Cardiology, in a tertiary care hospital in Kashmir. Eighty patients undergoing CRT implantation or upgrade were included. Detailed CS angiography was performed in both right anterior oblique and left anterior oblique views. Statistical analysis was performed using SPSS version 24. Results: The study population comprised 58.8% males and 41.2% females with a mean age of 59.42 ± 10.37 years. The lateral cardiac vein was the most frequently visualized (71.2%), followed by the anterior cardiac vein (68.8%). For LV lead placement, the lateral vein was most commonly used (62.5%), with the posterolateral mid (PLM) quadrant being the preferred location (33.8%). CS stenosis was observed in 16.2% of cases. Conclusion: Understanding CS anatomical variations is crucial for successful CRT implantation. The lateral cardiac vein and PLM quadrant represent optimal targets for LV lead placement in the Kashmiri population.