Key result
Dual-guidewire pull-back technique enables successful LV lead placement for CRT in double-barrel coronary sinus.
Why the study?
Coronary sinus anatomical variations such as a double-barrel coronary sinus can complicate left ventricular lead placement and lead to procedural difficulty during CRT implantation.
Case Report (n=1)
A modified pull-back technique with dual guidewires can facilitate successful CRT implantation in patients with a rare double-barrel coronary sinus.
Answers are grounded in this paper and cite their sources.
Requires vigilance for double-barrel CS during CRT to avoid lead misplacement; leaves open optimal pre-procedural imaging protocols.
BACKGROUND: Anatomical variations of the coronary sinus (CS) may complicate left ventricular lead placement during cardiac resynchronization therapy (CRT). A rare variant, the double-barrel coronary sinus, can result in inadvertent cannulation of non-target tributaries and procedural difficulty. CASE SUMMARY: We report a 45-year-old woman with symptomatic heart failure, left bundle branch block (LBBB), severe left ventricular dysfunction, and left ventricular dyssynchrony who underwent CRT implantation. Levophase coronary angiography demonstrated a double-barrel coronary sinus, with one channel continuing from the posterolateral vein and the other from the anterior interventricular vein. Repeated attempts to access the posterolateral vein preferentially entered the anterior interventricular vein. A modified pull-back technique using a sheath and dual guidewires enabled successful cannulation of the posterolateral branch. Left ventricular lead placement was achieved, resulting in significant QRS narrowing and marked clinical improvement. CONCLUSION: Recognition of double-barrel coronary sinus anatomy and use of alternative wiring techniques can facilitate successful CRT implantation.
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Sukumaran et al. (2026) conducted a case report in Heart failure with LBBB and severe left ventricular dysfunction (n=1). Cardiac resynchronization therapy (CRT) implantation using a modified pull-back technique was evaluated on Successful cannulation of the posterolateral branch and left ventricular lead placement. A modified pull-back technique using a sheath and dual guidewires enabled successful left ventricular lead placement for CRT in a patient with a double-barrel coronary sinus.
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