Po-03-219 angiographic assessment of coronary venous system for cannulation: lessons from high-speed rotational retrograde angiography

Venous ethanol ablation (VEA) is a novel effective therapy method for radiofrequency ablation refractory ventricular arrhythmias, especially the epicardial or intramural origin sites. Multielectrode catheters and balloons are usually used for mapping and VEA. However, there is limited data on the size and the collateral condition of the main tributaries of coronary venous system (CVS) in non-heart failure patients. To evaluate the size of the main tributaries of CVS for making better cannulation strategies via rotational retrograde angiography. We measured and analyzed the size of the great cardiac vein (GCV), the anterior ventricular vein (AIV) (including the first septal branch of AIV), and the main tributaries draining the posterior and lateral wall of the left ventricle in patients undergoing electrophysiology study. The diameters of the main tributaries of CVS were measured in the view that offered the least foreshortening and covering. High-speed rotational CVS angiography was performed on 60 patients. The diameter of GCV at the level of Vieussens valve (the “ostium” of GCV) and the distal end of GCV (junction of GCV-AIV) was larger in males than females (6.6±1.2 vs. 5.6±1.3mm, p=0.005; 5.1±0.9 vs. 4.6±0.8, p=0.045, respectively) while other tributaries showed no difference on genders. The diameter of middle cardiac vein (MCV), posterior vein (PV), lateral vein (LV), anterior ventricular vein and the first septal vein was 4.9±1.3, 3.0±1.0, 2.9±1.0, 4.4±1.0 and 1.4±0.7, respectively). 96% patients had collateral between main tributaries. Over half of them (62.5%) had collateral between MCV and AIV. We provide a systematic description and size measurement of CVS. Rotational angiography could be useful for the comprehensive assessment of CVS before ethanol ablation.