Anatomic Predictors Of Coronary Sinus Lead Stability In Patients Undergoing Cardiac Resynchronization Therapy

Coronary sinus (CS) placement for left ventricular (LV) pacing is a common method for biventricular pacing in cardiac resynchronization therapy (CRT). Such placement can still be technically challenging because of variations in CS anatomy. We assessed the effect of venous anatomy, caliber and tortuosity on CS lead placement in 18 of 20 consecutive patients undergoing CRT under the MRACLE-ICD protocol who had successful placement. CS and cardiac chamber anatomy were analyzed and significant CS tortuosity was defined angiographically as having a sharp curve with a deviation angle of greater than 60 degrees. We found that lead placement into a non-tortuous CS tributary required shorter initial placement time of 12.4 +/- 10.0 minutes versus 34.0 +/- 20.7 minutes for placement into a tortuous tributary (p = 0.01). However, leads placed into non-tortuous tributaries were associated with higher lead dislodgment acutely and chronically (at 4.7 +/- 2.9 month follow-up) compared to those placed in tortuous ones (43.8% versus 0%; p = 0.03). We conclude that tortuous CS tributary impedes CS lead placement but may provide better stability.