Original-clinicalEarly human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation
Section snippets
EVC
The EVC is an 8-Fr deflectable fiberoptic endoscope with a compliant distal balloon (Acumen Medical, Inc., Sunnyvale, CA). When the balloon is inflated, the operator can visualize the endocardial surface where the balloon makes contact. The catheter is also equipped with a lumen that can be used for contrast injections or to advance a guide wire for cannulation of the CS (Figure 1).
Study population
The study population consisted of all consecutive patients who underwent implantation of a CRT device for standard
Results
A total of 58 patients underwent attempted CRT device placement using the EVC to access the CS. The average age was 72 ± 12 years, and 82% were male (Table 1). Three of the 58 patients had failed a prior attempt at placement of an LV lead.
The EVC was able to visualize the CS ostium in all 58 cases. The mean time from insertion of the EVC into the sheath to visualization of the CS ostium was 6 ± 5 minutes. In 54 (93.1%) of 58 patients, cannulation of the CS was achieved with the EVC catheter.
Discussion
This is the first human study to use fiberoptic EVCs for real-time imaging of the CS ostium. This is also the first human study to use real-time imaging of the CS ostium to assist in LV lead placement. In this study, we demonstrate the technical feasibility and high reliability of visualizing and cannulating the CS with the EVC.
The exact reasons for historically unsuccessful cannulation of the CS are largely unknown. Precise anatomic reasons for CS cannulation failures are often difficult to
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Cited by (19)
2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: Implant and follow-up recommendations and management
2012, Heart RhythmCitation Excerpt :Early experience demonstrates reliable imaging of the CS and associated structures, facilitating cannulation when fluoroscopy alone had failed.135,136 Fiberoptic endoscopes are also commercially available and have been used to define right atrial and CS ostial anatomy.137,138 Preliminary studies show proof of concept in facilitating CS cannulation, but there is not widespread use of this technology.
The Use of Intracardiac Echocardiography and Other Intracardiac Imaging Tools to Guide Noncoronary Cardiac Interventions
2009, Journal of the American College of CardiologyCitation Excerpt :Such a balloon-tipped fiberoptic endoscope has been used successfully in humans (Fig. 2)(3). Anh et al. (4) used a deflectable fiberoptic endocardial visualization catheter (Acumen Medical, Inc., Sunnyvale, California) to successfully image the coronary sinus (CS) ostium and adjacent endocardial structures in 58 patients with the aim of facilitating implantation of a left ventricular pacing lead. The same group subsequently characterized CS valves by direct visualization (5).
I can see clearly now ... but at what cost?
2006, Heart RhythmUsefulness of Decapolar catheter via femoral approach on CS cannulation during CRT device implantation
2022, Journal of Arrhythmia
- 1
Christian Eversull, MD, and Nicholas J. Mourlas, PhD, are employed by Acumen Medical, Inc.
- 2
R. Hardwin Mead, MD, and L. Bing Liem, DO, have an equity interest in Acumen Medical, Inc.