Key result
Steerable EP catheter for CS cannulation linked to ~7.5-minute shorter fluoroscopy time vs conventional methods.
Why the study?
Coronary sinus cannulation and lead positioning during CRT implantation are challenging and time-consuming, and new techniques may reduce fluoroscopy time and contrast use.
Cohort (n=118)
No
Absolute Event Rate: 23.4% vs 30.9%
p-value: p=0.011
Steerable EP catheter use was associated with less fluoroscopy and contrast in CRT implantation; extends prior observations but requires prospective confirmation.
OBJECTIVES: The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS) cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT). BACKGROUND: Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation. METHODS: 176 consecutive patients with ischemic and non-ischemic heart failure undergoing CRT implantation from January 2008 to December 2012 at the University Hospital of Cologne were identified. During the study period two concurrent CS cannulation techniques were used: standard CS cannulation technique (standard-group, n = 113) and CS cannulation using a steerable electrophysiology (EP) catheter (EPCath-group, n = 63). Propensity-score matched pairs of conventional and EP-catheter guided CS cannulation made up the study population (n = 59 pairs). Primary endpoints were total fluoroscopy time and contrast medium amount used during procedure. RESULTS: The total fluoroscopy time was 30.9 min (interquartile range (IQR), 19.9-44.0 min) in the standard-group and 23.4 min (IQR, 14.2-34-2 min) in the EPCath-group (p = 0.011). More contrast medium was used in the standard-group (60.0 ml, IQR, 30.0-100 ml) compared to 25.0 ml (IQR, 20.0-50.0 ml) in the EPCath-group (P<0.001). CONCLUSIONS: Use of steerable EP catheter was associated with significant reduction of fluoroscopy time and contrast medium use in patients undergoing CRT implantation.
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Er et al. (2015) conducted a cohort in Advanced heart failure (n=118). Steerable electrophysiology (EP) catheter-guided coronary sinus cannulation vs. Conventional coronary sinus cannulation was evaluated on Total fluoroscopy time (minutes) (p=0.011). Use of a steerable electrophysiology catheter for coronary sinus cannulation significantly reduced median total fluoroscopy time (23.4 vs 30.9 minutes) and contrast medium use (25.0 vs 60.0 ml) compared to conventional methods.
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