Evaluation of a new multifunctional electrophysiology catheter for rapid cannulation of the coronary sinus

The recording of coronary sinus electrograms is an integral part of many electrophysiology (EP) studies. We recently developed a new decapolar catheter with a unique canted tip designed to aid the operator in rapidly cannulating the coronary sinus in order to reduce radiation exposure and overall procedure times. In this study, we prospectively and randomly compared the ease and time to successful insertion of this catheter (Daig CSL®, n = 15) into the coronary sinus with two conventional EP catheters, the Bard Josephson quadripolar catheter (n = 11) and the Cordis Webster deflectable tip decapolar catheter (n = 14). Patients undergoing EP studies were randomly assigned to one of the catheters and the operator was allowed up to 5 minutes of fluoroscopy time for successful placement of the catheter within the coronary sinus. All insertion attempts were performed through the right internal jugular vein except on two occasions where the left subclavian vein was used. Mean time to insertion for the catheter was 91 ± 18 s. (mean ± S.E.M.) versus 214 ± 32 s. for the Bard (p < 0.01) and 186 ± 31 s. for the Cordis Webster (p < 0.01). The Daig catheter could not be inserted into 1 patient within 5 min., but the coronary sinus was never successfully cannulated in this patient despite multiple attempts with several types of catheters. In contrast, the coronary sinus could not be successfully cannulated within the allotted 5 min. time in 4 patients assigned to the Bard Josephson and 6 patients assigned to the Cordis Webster catheters. These results support the conclusion that the time needed to cannulate the coronary sinus os can be significantly reduced by use of the Daig catheter with a special canted tip design when compared with conventional fixed curve and deflectable tip catheters.