Development of a multifunctional coronary sinus catheter

Given the importance of rapid cannulation of the coronary sinus (CS) during electrophysiology studies (EPS) and placement of pacing and defibrillator leads, we sought to design a simple catheter tip which would enable expeditious insertion of a multielectrode catheter into the CS os. The catheter was designed to be inserted from a superior approach, although the inferior approach is possible. The principal new design elements are a gentle distal curve and a cant at the soft tip. These help to facilitate engagement of the CS os and to anchor the catheter/lead in place, by gently pressing against both sides of the CS at the same time. The catheter can be constructed with a lumen and with multiple different electrode arrays depending upon the specific use. A decapolar catheter designed with closely-spaced electrodes (2-5 mm) has been used several hundred times during EPS. With more widely spaced (13 mm) electrodes, the new catheter has been used to sense and pace from both right atrial (RA) and CS sites, thereby eliminating the need for a separate RA lead. Total insertion times appear to be reduced and there have been no complications with the new tip design. Studies comparing ease of insertion of this new catheter with other catheters are currently underway. In summary, a CS catheter tip designed with a cant at the tip appears to: 1) facilitate CS cannulation during EPS; 2) reduce the total number of catheter needs for EPS; and 3) may be useful for temporary and permanent pacing, sensing and defibrillating the atria and ventricle.