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Coronary sinus catheterization via a femoral vein

Femoral Vein Approach to the Corona Sinus Durin Electropx ysiology Stu 8 ies In the study of Daoud et al.’ the placement of electrode catheters into the coronary sinus was described using a femoral vein approach. They used a deflectable tip catheter that is typically more expensive than a standard electrode catheter. We reported a very easy and cost-saving transfcmoral catheterization of the coronary sinus.*,” An 8Fr coronary-guiding catheter for percutaneous transluminal coronary angioplasty (Amplatz 2 for the right coronary artcry) was inserted into the femoral vein using a sheath and a guidewire. The catheter was advanced under fluoroscopic control into the right atrium. The catheter was turned clockwise and placed inside the coronary sinus ostium. Contrast medium may be injected as a reference for catheter position. In 25 patients with Wolff-Parkinson-white syndrome, a 5Pr electrode was advanced through the guidin_p catheter into the coronary sinus. An intracardiac electrogram was recorded. Catheterization of the coronary sinus was successful in all patients. After cannulation of the femoral vein, the time required for this procedure was 1 to 2 minutes. There was no complication. Our technique is safe, simple to apply, and inexpensive. It is an encouraging adjunct that can bc used as an alternative to the brachial, subclavian, or internal jugular vein approach. Jobst Nitsch, MD Bocholt, Gcrmanq 1994 Coronary Sinus Catheterization Via a Femoral Vein Daoud et alI state that catheterization of the coronary sinus via the femoral vein approach during an electrophysiologic procedure can save time and avoid the possible complications associated with an internal jugular or subclavian vein approach.*,” They also mention that the use of a deflectable-tip catheter may have a cost disadvantage. In our institution, we have used a femoral approach to place the electrode catheter into the coronary sinus instead of the traditional internal jugular approach since October 1993. However, we’ve used the standard electrode catheter for the procedure. Among 112 patients who underwent an elcctrophysiologic procedure at the hospital, 74 subjects accepted catheterization of the coronary sinus via a femoral vein, whereas the remaining 38 subjects underwent catheterization via an internal jugular vein. A 6Fr standard electrode catheter was routinely directed into the coronary sinus under fluoroscopic guidance using a 60” left anterior oblique view before electrophysiologic study (Figure I). In both groups, the time required to cannulate the vein and catheterize the coronary sinus was measured. With both approaches, a second operator attempted to catheterize the coronary sinus if the first operator was not successful within 20 minutes. Catheterization of the coronary sinus was successful in 36 of 38 patients (95%) who underwent the internal jugular approach, and the mean time required was 14.5 f 9.5 minutes. With use’of the femoral vein approach, the coronary sinus was successfully catheterized in 71 of 74 patients (96%) in a mean of 10.1 + 7.8 minutes, which was a signilicantly shorter time than with the internal jugular approach (p -&(~I). The rates of failure of the first operator were 8% for the internal jugular group and 7% for the femoral group. There were no complications m our study. Our findings provide further evidence that catheterization of the coronary sinus via the femoral vein can provide the benefits of shorter time required and fewer complications. The use of a standard electrode catheter also has a cost ad- FIGURE 1. Fluoroxopic 60” left onterior oblique view of o standard electrode catheter in the coronary sinus (CS). Catheters in the His bundle (HB) position, right atrium (RA), and right ventricle (RV) ore also shown. vantage over that of a deflectable-tip catheter, as Daoud et al’ mentioned. Technique training is the limiting step of performing the procedure in our manner. With skillful manipulation, we believe that the femoral vein approach with a standard electrode catheter can be a good new method. Tzong-Luen Wang, !&I Jiunn-Lee tin, MD Wen-Pin Lien, MD Taipei, Taiwan, Republic of China 30 August 1994 1. Daoud PG. Kiehauer M. Hakr 0. Jentxr J. Man C. W~lliamcon HI). Hummel JI). Stricktxrger SA. blorad~ F Placement of electralc catheter\ inro the cvn>nar)cl”“\ during electroph>a~oli>~y prwdurcs sing a lemoral vein approach Am .I (brdiol I’YM; 7J:I9+195. 2. Mirchell SF,:. Clark RA. Cumphcarions ul ccmral wmus calhetcrin~rion. AJR 1070:133:467476. 3. Orchaugh SL. Vcnoux air embolism. clinical and experimenral cunsidentions. Crir (.hru .Mrd lW2;20: 116%1177 29 August &cordial Honk Due to Tricuspid Regurgitation I submit the following clinical notes and autopsy findings on a patient whose case appeared in Tile American Journal I$ Cardkh&~ in January 1975.’ Subsequent to submission of the manuscript for publication, the patient developed pneumonia. and then recurrent bouts of heart failure during 1974: in December 1974 she was thought to have recurrent myocardial infarction and pulmonary embolus. In January 1975, cardiovascular shock and cardiac arrest occurred. She was resuscitated but died in her sleep February 20, 1975, at the age of 51 years. Lettcrz ticular diolq@ the (with written (from article must rare the I.‘nited in States) concemin_e a par- T/w Americnn be rcceivcd and within Jortnd should of Car-01 typebe limited 2 months article’s pages. publication. exceptions) Two copies to 2 double-spaced must be suhmittcd. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Cardiology Elsevier

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