The Buddy Wire Technique: Accessing Lateral Coronary Veins While Maintaining Coronary Sinus Position

Abstract

There is compelling data to place the coronary sinus lead (CSL) in a lateral or posterolateral tributary. Coronary sinus venography often demonstrates the absence of easily accessible lateral veins or those with sufficient size to accommodate the CSL. The operator may choose to deploy the CSL in the anterior vein but publications and experience highlight the lack of resynchronization benefit when the CSL is deployed in this location. There is often a posterolateral vessel or the middle cardiac vein (MCV) originating from near the coronary sinus (CS) os. These vessels require the operator to pull the CS guide essentially out of the CS to allow successful access. Cannulation of the coronary sinus (CS) is often challenging, and the risk of losing access to the CS may dissuade the implanter from attempting access to a vessel near the CS os. We describe a technique to access vessels near the CS os while maintaining secure position in the main body of the CS.

Achieving Permanent Left Ventricular Pacing—Options and Choice

“…Inserting a guide wire or lead into a side branch can be difficult or impossible due to a sharp, oblique, or awkward angle of origin from the main CS body, tortuosity, stenosis, or small caliber. To overcome these anatomical barriers, many ingenious technologies (e.g., telescopic subselection catheters, 22,23 deflectable catheters) and techniques (e.g., multiple guide wire techniques, 24–26 coronary venoplasty 27,28 ) have been invented. In fact, many technologies and techniques originally developed for percutaneous coronary artery interventions, including cutting balloons, 29 rotational atherectomy, 30 noncompliant balloons with 31 (“focused force”) or without an extra “buddy” guide wire, 32 have been used in coronary venoplasty.…”

Coronary Sinus Lead Implantation

“…7,9 Transvenous LV lead implantation was new in 1998. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Collaborative development by physicians and industry has resulted in a variety of new tools such as a 9-French (Fr) peel-away sheath, coronary sinus (CS) cannulation assist catheter, vein selectors, and an inner guide capable of delivering up to 7-Fr leads. 10 CRT devices are implanted predominantly by cardiac electrophysiologists employing new skills borrowed from interventional cardiologists and radiologists.…”