Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy: A high-speed rotational venography study

BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributaries can facilitate electro-physiological procedures, such as cardiac resynchronization therapy (CRT) and catheter ablation. Venography also allows visualization of the left atrial (LA) veins, which may be a potential conduit for ablative or pacing strategies given their proximity to foci that can trigger atrial fibrillation. OBJECTIVE The aim of this study was to provide a detailed description of CV anatomy using rotational venography in patients undergoing CRT. METHODS Coronary sinus (CS) size and the presence, size, and angutation of its tributaries were determined from the analysis of rotational CV angiograms from 51 patients (age 68 +/- 11 years; n = 12 women) undergoing CRT. RESULTS The CS, posterior veins, and lateral veins were identified in 100%, 76%, and 91% of patients. Lateral. veins were less prevalent in patients with a history of lateral myocardial infarction than in patients without such a history (33% vs. 96%; P =.014). The diameters of the CS and its tributaries were fairly variable (7.3-18.9 mm for CS, 1.3-10.5 mm for CS tributaries). The CS was larger in men than in women and in cases of ischemic than in cases of nonischernic cardiomyopathy (all P <.05). The vein of Marshall, the most constant LA vein, was identified in 37 patients; its diameter is 1.7 +/- 0.5 mm, and its takeoff angle is 154 degrees +/- 15 degrees, making the vein potentially accessible for cannulation. CONCLUSIONS Differences in CV anatomy that are related to either gender or coronary artery disease could have important practical implications during the left ventricular lead implantation. The anatomical features of the vein of Marshall make it a feasible potential conduit for epicardial LA pacing.