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.