Multi-site multi-polar left ventricular pacing through the coronary sinus (CS) may be preferred over endocardial right ventricular or surgical epicardial pacing in the presence of tricuspid valve disease. However, the required lead placement can be difficult through a persistent left superior vena cava (PLSVC), as the CS tends to be hugely dilated and side branches tend to have sharp angulation...

Introduction Cardiac resynchronization therapy (CRT) has revolutionized the treatment of advanced heart failure. However, effective placement of a left ventricular (LV) pacing lead via the coronary venous system is subject to anatomical constraints. We present the case of a 78-year-old man with a history of dilated cardiomyopathy and severe LV impairment. It was not possible to implant a lead i...

Introduction A human anatomic study has shown that a cuff of striated muscle consistently surrounds the venous wall of the coronary sinus (CS) and is connected to the left atrium (LA) by muscular bundles in a variable fashion. The presence of electrical connections between the CS musculature and LA myocardium provides a potential anatomic substrate for reentry. In fact, atypical atrial flutter ...

OBJECTIVE To evaluate the usefulness of examining the coronary sinus (CS) anatomic diameter as an additional surrogate marker of severity in chronic rheumatic valve disease (RVD). METHODS In this cross-sectional observational study, we echocardiographically analyzed 88 patients with RVD, and 104 normal subjects in the Department of Cardiology, Gaziantep University Medical Faculty, Gaziantep, ...

Catheter ablation of Wolff-Parkinson-White syndrome is associated with up to 5% of failure. Coronary sinus (CS) abnormalities or connections between CS myocardial coat and left ventricular epicardium are associated with posteroseptal and left posterior accessory pathways (AP). A 41-year-old patient with WPW syndrome was referred to our hospital after three unsuccessful ablations. The 12-lead EC...

Picture 1. (A) A chest X-ray showing enlargement of the right atrium (RA) (arrow), (B) An echocardiogram showing dilatation of the coronary sinus (CS) (arrow), (C) A multislice computed tomogram showing enlargement of the RA, (D) A multislice computed tomogram showing persistent left superior vena cava (SVC) (arrow) which drained into the RA through the CS. LAD: left atrial dimension, LVDd: lef...

We herein report a case of atrial tachycardia (AT) originating from the dilated coronary sinus (CS) connected to a persistent left superior vena cava. The earliest activation site of AT was localized at the superior CS ostium, identified using a novel ultra-rapid high-density mapping system (Rhythmia™). Successful ablation was performed at the corresponding position. This report demonstrated th...

OBJECTIVES The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS) cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT). BACKGROUND Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation. METHODS 176 consecutive patients...

Introduction The ligament and vein of Marshall (VOM), with its richly innervated sympathetic and parasympathetic nerves, runs epicardially between the coronary sinus (CS) and left pulmonary veins (LPVs), and can serve as a trigger and substrate for reentry of atrial fibrillation (AF) and atrial tachycardia. Here we describe the case of an AF patient with preferential conduction and decremental ...

The combination of coronary arteriovenous fistula to the coronary sinus (CS), dilatation of the entire length of coronary artery, coronary aneurysm and persistent left superior vena cava (PLSVC) is very rare. We present the case of a 63-year-old female admitted for dyspnea on exertion, orthopnea, and facial edema. Echocardiography detected a giant coronary artery with shunt flow, dilated CS and...