Comparison of coronary sinus catheterization via femoral or subclavian vein approach

AIM: To compare the effectiveness and safety of coronary sinus catheterization via femoral or subclavian vein approach. METHODS: Six hundred and forty-one consecutive patients undergoing electrophysiological study or radiofrequency catheter ablation admitted to our department from January2010 to May 2012 were prospectively assigned in a random fashion to either the femoral vein access( FVA) with a steerable curve deca-polar catheter( n = 321) or the subclavian vein access( SVA) with a fixed curve deca-polar catheter( n = 320). If one approach is unsuccessful,the other approach was tried. The success rate,complication rate and exposure time was compared. RESULTS: In the SVA group,puncture was successful in 317 cases( puncture success rate was 98. 8%). Among the four failed cases,three were diagnosed with pneumothorax after postoperative examination,and the other procedure was cancelled due to mispuncture of the subclavian artery and a 6F sheath was inserted. One of the three pneumothorax patients needed closed thoracic drainage,and the other two absorbed automatically without medical intervention. None of the patients had any sequelae. In the SVA group,complication rate was1. 2%; 307 /320 were successful in placing coronary sinus electrode,success rate of catheteration was95. 9%,12 of the failed 13 cases( 4. 1%) were successfully catheterized via femoral vein approach. All333 cases( the 13 failed patients were alternated to this group; thus,the number of this group was 333)were successfully punctured in the FVA group,the punture success rate was 100%,three cases failed in coronary sinus catheterization,success rate of catheteration was 99. 1%. The three failed cases were successfully catheterized via femoral venous pathways after retrograde coronary vein angiography. The success rate of electrode placement was significantly higher in the FVA group than in the SVA group( 99. 1 vs. 95. 9%,P < 0. 01). The rate of severe complications was slightly higher in the SVA group than in the FVA group without significant difference. The success rate of puncture,exposure time ( 77± 40) s vs.( 75 ± 46) s,P > 0. 05 was similar between groups. Overall success rate of the FMV group was significantly higher than the SVC group( 99. 1 vs. 94. 7%,P < 0. 01). CONCLUSION: Both approaches have a high success rate in coronary sinus electrode placement and a low incidence of complications. Overall success rate of the FMV group is significantly higher than the SVC group.