Elsevier

Heart Rhythm

Volume 3, Issue 8, August 2006, Pages 875-878
Heart Rhythm

Original-clinical
Early human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation

https://doi.org/10.1016/j.hrthm.2006.04.029Get rights and content

Background

Despite improvements in cardiac resynchronization therapy (CRT) implantation techniques, a significant minority of CRT attempts are unsuccessful. Inability to cannulate the coronary sinus (CS) because of difficult anatomy is a major reason for unsuccessful CRT implantation. Direct visualization of intracardiac structures during the implant may facilitate access into the CS. The present study describes CRT implantation with the aid of an endocardial visualization catheter (EVC).

Methods

Fifty-eight consecutive patients (mean age 72 ± 12 years; ejection fraction 26.2% ± 7.0%; New York Heart Association [NYHA] class 2.9) underwent CRT implantation using a steerable fiberoptic EVC (Acumen Medical, Inc., Sunnyvale, CA).

Results

The EVC was able to visualize the CS ostium in all cases. The CS was successfully cannulated in 57 (98.3%) of 58 patients. The time from vascular access to CS visualization was 6 ± 5 minutes, and the total time to CS access was 8 ± 6 minutes. Successful left ventricle (LV) lead implantation was accomplished in 55 (94.8%) of 58 patients. Three patients who had a previous history of failed LV lead implantation were successfully implanted using the EVC.

Conclusion

Fiberoptic imaging of intracardiac structures during CRT implantation may be performed rapidly in a wide range of patients with an EVC. The ability to visualize right atrial anatomy may aid CS access and LV lead implantation.

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

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 Rhythm
    Citation 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 Cardiology
    Citation 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).

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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.

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