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CLINICAL RESEARCH: VIEWPOINT

The Coronary Venous Anatomy

A Segmental Approach to Aid Cardiac Resynchronization Therapy

Jagmeet P. Singh, MD, PhD^_*,_*, Stuart Houser, MD, E. Kevin Heist, MD, PhD^_* and Jeremy N. Ruskin, MD^_*

^_* Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cardiac Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Manuscript received December 14, 2004; revised manuscript received March 23, 2005, accepted April 5, 2005.

^_* Reprint requests and correspondence: Dr. Jagmeet P. Singh, Massachusetts General Hospital, Cardiac Arrhythmia Service, GRB 109, 55 Fruit Street, Boston, Massachusetts 02114. (Email: jsingh{at}partners.org).

The coronary sinus is the gateway for left ventricular (LV) epicardial lead placement for cardiac resynchronization therapy. The implanting electrophysiologist is usually challenged by a high degree of variability in the coronary venous anatomy, making it important to have a more consistent and uniform segmental approach to describe the coronary venous tree and its branches. Classifying the coronary sinus branches and tributaries by the segment of their location rather than by conventional anatomic names (i.e., middle cardiac vein, great cardiac vein, and so on), would provide more relevant anatomic and functional information at the time of LV lead placement. This would enable the implanting physician to proactively correlate the venous anatomy with the segmental wall motion abnormalities or dyssynchrony, as defined by echocardiography and other imaging modalities. The current viewpoint calls for a more systematic segmental approach for describing the coronary venous anatomy.

Abbreviations and Acronyms   CT = computed tomography   LV = left ventricle/ventricular

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