Cardiac Resynchronization Therapy Implantation in a Double-Barrel Coronary Sinus.
Suresh Kumar Sukumaran, Sasinthar Rangasamy, Sathish Kumar Subbaraj et al.
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Case in brief
A 45-year-old woman with symptomatic heart failure, left bundle branch block, severe left ventricular dysfunction, and dyssynchrony underwent cardiac resynchronization therapy implantation. Levophase coronary angiography showed a double-barrel coronary sinus: one channel continued from the posterolateral vein and the other from the anterior interventricular vein. Attempts to enter the posterolateral vein repeatedly led into the anterior interventricular vein. A modified pull-back technique using a sheath and dual guidewires enabled posterolateral branch cannulation and left ventricular lead placement. The procedure was followed by significant QRS narrowing and marked clinical improvement.
What made this case unusual
The double-barrel coronary sinus anatomy directed repeated attempts to access the target posterolateral vein into the anterior interventricular vein, creating a specific lead-placement challenge.
Diagnostic / clinical pearl
When coronary sinus anatomy complicates CRT lead placement, levophase angiography can reveal variant channels; a modified pull-back technique with a sheath and dual guidewires enabled target-branch cannulation in this case.