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Cardiac Electrophysiology Clinics Mar 2019Cardiac resynchronization therapy (CRT) has become the gold standard for patients with systolic left ventricular function, left ventricular ejection fraction less than... (Review)
Review
Cardiac resynchronization therapy (CRT) has become the gold standard for patients with systolic left ventricular function, left ventricular ejection fraction less than or equal to 35%, wide complex QRS, and symptomatic heart failure. Annual implantation volume has steadily increased because of expanding indications for CRT. Improved survival resulted in many of these patients having their CRT devices for many years and eventually requiring an increased number of device-related procedures, including coronary sinus lead revisions and replacements following a coronary sinus lead extraction.
Topics: Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Coronary Sinus; Device Removal; Heart Failure; Humans; Reoperation
PubMed: 30717845
DOI: 10.1016/j.ccep.2018.11.014 -
Current Cardiology Reports Apr 2016Refractory angina is a life-disabling disease, even with the discovery of antianginal drugs and the advances in revascularization surgically or percutaneously to improve... (Review)
Review
Refractory angina is a life-disabling disease, even with the discovery of antianginal drugs and the advances in revascularization surgically or percutaneously to improve symptoms. Over the last decade a renewal of interest in an old surgical modality of narrowing the coronary sinus has evolved. Although the surgical procedure idea was born in 1940 it was overshadowed by the development of coronary artery bypass graft and percutaneous interventions. Recently, a percutaneous approach of reducing the coronary sinus size has been developed and several clinical studies have been reported in refractory angina patients. We review the history of coronary sinus intervention, and explore coronary sinus stent possible mechanism of action, device design, and the clinical data supporting its use.
Topics: Angina, Stable; Animals; Clinical Trials as Topic; Coronary Angiography; Coronary Artery Bypass; Coronary Sinus; Humans; Quality of Life; Stents; Swine
PubMed: 26922589
DOI: 10.1007/s11886-016-0710-4 -
Cardiology 2019Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we... (Review)
Review
Atrial fibrillation (AF) is the most frequent atrial arrhythmia. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. But the most challenging type is still persistent AF. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. According to many studies, PVI alone is not enough to deal with persistent AF. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. This review will also inform readers about application of CS in other electrophysiological procedures.
Topics: Atrial Fibrillation; Catheter Ablation; Coronary Sinus; Humans; Recurrence
PubMed: 31476754
DOI: 10.1159/000501819 -
Herzschrittmachertherapie &... Jun 2022Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge... (Review)
Review
Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge and Thebesian valve, as well as within the CS, such as Vieussen's valve and the vein of Marshall, are important to understand and differentiate during implantation or to identify earlier by imaging. Anatomic knowledge is mandatory to select the most suitable side branch for lead implantation. Modern tools and techniques almost always enable other anatomic problems, such as tortuous, small, short, or overly straight side branches, to also be overcome.
Topics: Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Coronary Sinus; Heart Failure; Humans
PubMed: 35648250
DOI: 10.1007/s00399-022-00863-x -
Journal of Interventional Cardiac... Dec 2023Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the...
BACKGROUND
Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the safety and efficacy of ablations in the coronary sinus.
METHODS
This is a retrospective study of all patients who underwent ablations in the coronary sinus from October 2013 to October 2021 at a single center. Clinical presentation, type of arrhythmia causing tachycardia, ablation procedure, and outcome were recorded.
RESULTS
A total of 27 patients were included in the study. Nineteen (69%) of those followed up received a diagnosis of Wolff-Parkinson-White syndrome (WPW), 4 (15%) were cases of supraventricular tachycardia with concealed accessory pathway (AP), 2 (8%) were cases of focal atrial tachycardia, and 2 (8%) were cases of permanent junctional reciprocating tachycardia. Negative delta wave was noteworthy especially in lead II in 11/19 (58%) cases and coronary sinus diverticulum was detected in the WPW cases. Of those with manifest AP (19 cases), 15 (79%) had a high-risk AP and the AP in all WPW cases was adenosine unresponsive. Radiofrequency (RF) catheter ablation was performed in 25/27 (93%) cases during the procedure, and 16/25 (64%) of these were irrigated RF catheters. No complications were observed in the follow-up, including coronary artery injury.
CONCLUSIONS
Catheter ablation of supraventricular tachyarrhythmias can be accomplished effectively and potentially safely within the coronary sinus. Coronary sinus diverticula should be suspected in patients with manifest posteroseptal APs who have a previous failed ablation and typical electrocardiographic signs.
Topics: Humans; Child; Coronary Sinus; Retrospective Studies; Wolff-Parkinson-White Syndrome; Accessory Atrioventricular Bundle; Tachycardia, Supraventricular; Tachycardia; Electrocardiography; Catheter Ablation
PubMed: 37864653
DOI: 10.1007/s10840-023-01675-w -
Circulation. Cardiovascular Imaging Nov 2023
Topics: Humans; Coronary Sinus; Aortic Aneurysm; Tricuspid Valve; Sinus of Valsalva
PubMed: 37869891
DOI: 10.1161/CIRCIMAGING.123.015513 -
Current Cardiology Reports Mar 2021The prevalence of angina despite optimal medical therapy is high among patients with coronary chronic total occlusions. Despite advancements in techniques and operator's... (Review)
Review
PURPOSE OF REVIEW
The prevalence of angina despite optimal medical therapy is high among patients with coronary chronic total occlusions. Despite advancements in techniques and operator's experience, percutaneous revascularization of coronary chronic total occlusions is still associated with a not negligible risk of failures and complications. The Coronary Sinus Reducer, a new device developed to improve angina, has shown promising results in terms of efficacy and safety in patients with refractory symptoms. The aim of this review is to summarize the evidence so far available and to guide clinicians in the selection of patients with chronic total occlusions that could benefit more from Coronary Sinus Reducer implantation.
RECENT FINDINGS
A recently published study suggests a clear value of this device in patients with chronic total occlusions. This is likely to be related to the presence of a well-developed collateral circulation. A careful evaluation of risks and benefits of both myocardial revascularization and Coronary Sinus Reducer implantation should be done in all the cases in order to better define the optimal strategy for the patient. The Coronary Sinus Reducer implantation has a rationale in patients with chronic total occlusion as an alternative or additional therapy to myocardial revascularization.
Topics: Angina Pectoris; Coronary Occlusion; Coronary Sinus; Humans; Percutaneous Coronary Intervention; Treatment Outcome
PubMed: 33655425
DOI: 10.1007/s11886-021-01463-w -
Folia Medica Cracoviensia 2015Based on the review of the current literature and our own experiences we reviewed the literature paying most attention to human venous coronary system with special... (Review)
Review
Based on the review of the current literature and our own experiences we reviewed the literature paying most attention to human venous coronary system with special respect to coronary sinus - the largest vein of the heart. Many details still remain obscure, although most of modern procedures require deep anatomical knowledge on cardiac veins. Many of developmental remarks are still not clear, regarded to development of the vessels of the heart in association with origin of heart conductive system.
Topics: Cardiac Surgical Procedures; Coronary Circulation; Coronary Sinus; Coronary Vessels; Heart Atria; Heart Diseases; Heart Ventricles; Humans
PubMed: 26774627
DOI: No ID Found -
International Journal of Cardiology Nov 2021
Topics: Angina Pectoris; Coronary Sinus; Humans; Schools; Technology; Treatment Outcome
PubMed: 34371031
DOI: 10.1016/j.ijcard.2021.07.062 -
Expert Review of Cardiovascular Therapy Jan 2017Chronic refractory angina is often a disabling condition, predominantly due to severe obstructive coronary artery disease, that is inadequately controlled by optimal... (Review)
Review
Chronic refractory angina is often a disabling condition, predominantly due to severe obstructive coronary artery disease, that is inadequately controlled by optimal medical therapy and not amenable to further percutaneous or surgical revascularization. mortality rates associated with this condition are relatively low in clinically stable patients. however, it is associated with a high hospitalization rate and a reduction in both exercise capacity and quality of life. due to the paucity of available treatment options, there is an unmet need for new therapies for these patients and for a reduction in the associated economic healthcare burden. Areas covered: This review is focusing on the clinical evidence and technical aspects of this new therapeutic modality in refractory angina patients unsuitable for revascularization. Expert commentary: The Coronary Sinus Reducer (Neovasc Inc. Richmond B.C., Canada) is a new percutaneous device designed to achieve a controlled narrowing of the coronary sinus that may alleviate myocardial ischemia, possibly by redistributing blood from the less ischemic sub-epicardium to the more ischemic sub-endocardium, or by neoangiogenesis. Recently, a randomized, double-blind, multi-center clinical trial demonstrated a benefit in improving symptoms in 104 refractory angina patients, when compared to placebo.
Topics: Angina, Stable; Catheterization, Central Venous; Central Venous Catheters; Coronary Sinus; Humans; Pain, Intractable; Prosthesis Design; Prosthesis Fitting; Quality of Life; Treatment Outcome
PubMed: 27935738
DOI: 10.1080/14779072.2017.1270755