Evaluation of femoral approach to coronary sinus catheterisation in electrophysiological and ablation procedures: Single centre experience

Background: It has been reported that the cannulation of coronary sinus (CS) from the femoral approach is safer than the traditional subclavian approach but is associated with a lower rate of success. We aimed to test the validity of this claim. Method: We evaluated retrospectively 1320 consecutive patients who underwent electrophysiological study (EPS) or ablation over a period of three years using a prospectively collected data. In cases requiring CS cannulation, it was attempted first from the femoral approach, switching if necessary to a subclavian approach when the femoral route failed. Results: Out of 1320 patients, 1165 (88.3%) required CS cannulation. The CS was successfully cannulated from the femoral approach in 99.3% of the cases in which it was attempted. One patient (0.09%) developed transient first degree atrioventricular block during an ablation procedure for AV nodal re-entrant tachycardia during cannulation of the CS that resolved within 3 min. Femoral access failed in 8 patients. In 4 of these cases, the procedure was concluded using CS cannulation via subclavian or jugular venous access. In the other 4 cases, the procedure was concluded successfully without CS cannulation, including an AF ablation in which CS cannulation proved impossible by either subclavian or femoral approach. Conclusion: Femoral access can be used for CS cannulation with a high rate of procedural success in the vast majority of patients undergoing EPS and ablation. This approach is safe, and associated with a high rate of procedural success.