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

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. 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. 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. 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

Flutter wave polarity on surface ECG and endocaridal activation in typical counter clockwise atrial flutter

To analyse the endocardial activation of typical counter clock wise atrial flutter [CCW]. A retrospective study of 24 cases admitted over a period of 5 years for atrial flutter ablation at St. Georges Hospital, London. The electrophysiological study were reviewed from optical disc and right atrial activation analysed in all cases of typical CCW atrial flutter. In all the 24 cases of typical CCW atrial flutter the right atrial activation is in upward direction along the septum and downward along the right atrial lateral wall, the inferior leads on ECG represent it as "F" waves. In CCW atrial flutter the negative flutter wave in inferior leads represent lateral and anterior right atrial activation while descending limb represents septal activation