Angiographic findings and treatment of coronary sinus spasm during left ventricular lead placement: A case report


      A 71-year-old man with ischemic cardiomyopathy, a left ventricular (LV) ejection fraction of 23 %, left bundle branch block with a QRS duration of 160 milliseconds, and nonsustained ventricular tachycardia was admitted for cardiac resynchronization therapy combined with an implantable defibrillator. During LV lead placement, the guiding sheath encountered strong resistance during deep coronary sinus (CS) cannulation. CS venography showed a complete occlusion, and we diagnosed venospasm because the occlusion self-resolved after several minutes. After administering intravenous isosorbide dinitrate and waiting several minutes without manipulating the catheters, we could successfully place the LV lead in the target branch. Although CS spasm is considered a rare complication of LV lead placement, in some cases catheter manipulation can trigger it. Therefore, clinicians should recognize its possibility and be aware of the associated angiographic findings and treatment.

      Learning objective

      In some cases, coronary sinus (CS) spasm can be triggered during left ventricular lead placement. It presents as occlusion with abrupt tapering on CS venography. After administering intravenous nitrates and waiting several minutes without manipulating the catheters, the spasm resolves and the catheter can be advanced.


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        • Nägele H.
        • Behrens S.
        • Azizi M.
        What can happen during coronary sinus lead implantation: dislocation, perforation and other catastrophes.
        Herzschrittmacherther Elektrophysiol. 2007; 18: 243-249
        • Woollett I.
        • Pinney S.
        • Magnano A.R.
        Balloon dilatation of coronary sinus spasm during placement of a biventricular pacing lead.
        Circulation. 2005; 111: E304-E305
        • Russo V.
        • Ilaria De Crescenzo I.
        • Ammendola E.
        • Cavallaro C.
        • Santangelo L.
        • Calabro R.
        Coronary sinus spasm during left ventricular lead implantation for biventricular pacing.
        Europace. 2007; 9: 528-530
        • Heist E.K.
        • Singh J.P.
        • Mela T.
        • Ruskin J.N.
        Coronary venospasm causing chest pain during implantation of cardiac resynchronization therapy.
        Heart Rhythm. 2007; 4: 1108-1109
        • Ellis C.R.
        • Jongnarangsin K.
        Successful left ventricular lead implantation following intracoronary sinus nitroglycerin for isolated lateral coronary sinus branch venous spasm.
        J Innov Card Rhythm Manag. 2010; 1: 91-93
        • Kapoor A.
        • Kumar S.
        • Batra A.
        Percutaneous coronary vein angioplasty for severe spasm of the posterolateral vein during bi-ventricular pacing.
        J Invasive Cardiol. 2011; 23: E170-E172
        • Chauvin M.
        • Shah D.C.
        • Haïssaguerre M.
        • Marcellin L.
        • Brechenmacher C.
        The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans.
        Circulation. 2000; 101: 647-652
        • Worley S.J.
        • Gohn D.C.
        • Pulliam R.W.
        Coronary vein rupture during venoplasty for LV lead placement.
        Pacing Clin Electrophysiol. 2008; 31: 904-907