CORONARY VENOUS SYSTEM DISEASES

Coronary_Venous_System_Diseases

CORONARY VENOUS SYSTEMAND CARDIAC RESYNCHRONIZATION THERAPY

Mustafa Ebik1 Gökay Taylan2

1Edirne Sultan 1. Murat State Hospital, Department of Cardiology, Edirne, Türkiy
2Trakya University, Faculty of Medicine, Department of Cardiology, Edirne, Türkiye

Ebik M, Taylan G. Coronary Venous System and Cardiac Resynchronization Therapy. In: Altay S, Akşit E, Kemaloğlu Öz T editor. Coronary Venous System Diseases. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.131-141.

ABSTRACT

Cardiac Resynchronization Therapy (CRT) is a crucial treatment method that reduces morbidity and mortality in heart failure patients with appropriate indications. The most frequently used method for left ventricular (LV) pacing during CRT implantation is the transvenous placement of the electrode us- ing the coronary venous system (CVS). The most critical factor determining the success of the therapy is the placement of the LV electrode in an optimal location via the CVS. A comprehensive understand- ing of CVS anatomy facilitates successful coronary sinus (CS) cannulation, appropriate target vein selection, and stable lead positioning. Concurrently, it allows for the anticipation of potential difficul- ties encountered during the procedure and the prevention or effective management of possible compli- cations. The CVS anatomy exhibits significantly higher variability compared to the coronary arterial system. This high variability rate can lead to significant challenges during interventional procedures such as CRT implantation. Therefore, imaging modalities such as venography, CT, and MRI are used for preoperative planning and intraoperative guidance. Optimal vein selection involves several crite- ria including anatomical suitability (lateral/posterolateral, non-apical positions), electrical delay (long Q-LV interval), lead stability, avoidance of phrenic nerve stimulation (PNS), and distance from scar tissue. Procedural complications include coronary venous dissection/perforation, cardiac tamponade, lead dislodgement, and infection. Although technological advances have improved procedural suc- cess rates, the fundamental elements of CRT success remain clinical assessment, accurate anatomical evaluation, and an experienced team-based approach. Mastery of CVS anatomy and patient-centered strategies are indispensable for maximizing the benefits of CRT treatment and increasing patient safety.

Keywords: Coronary venous system; Cardiac resynchronization Tterapy; Coronary sinus; Heart failure; Coronary vein selection; Coronary venous challenges; Coronary vein complications

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