Coronary sinus catheterization during electrophysiological study via a femoral vein approach

Background. Coronary sinus catheterization is essential for electrophysiologic studies for supraventricular tachycardia. This study was designed to compare the benefit and risk between conventional internal jugular vein approach and femoral vein approach to catheterize the coronary sinus. Methods. One-hundred and eighty patients were randomized into those with femoral vein approach (n = 107) and those with internal jugular vein approach (n = 73). Catheterization was performed by a standard electrode catheter. No differences in age or gender existed between the two groups. The time required to cannulate the vein and catheterize the coronary sinus, the time of radiation exposure, total dose of radiation and complications were recorded and compared between these two groups. Results. The coronary sinus was successfully catheterized in 70 of 73 patients (96%) using an internal jugular vein approach, and in 103 of 107 patients (97%) using a femoral vein approach. The time required to complete the procedure was significantly shorter in those with the femoral vein approach than those with an internal jugular vein approach (7.8 ± 5.6 minutes vs 12.8 ± 10.2 minutes, p < 0.001). With use of cannulation via a femoral vein, there was also shorter duration of radiation (5.9 ± 3.7 minutes vs 10.0 ± 8.4 minutes) and a lower dose of radiation exposure (12 ± 6 R vs 22 ± 12 R, p < 0.005). Three of the patients with internal jugular method suffered from local hematoma whereas none occurred in the group. Conclusion. Catheterization of the coronary sinus during an electrophysiologic procedure can be accomplished by the femoral vein approach with the benefit of time- and cost-savings, as well as fewer complications.