Author + information
- Su. Verma,
- Sa. Verma,
- J. Wiley and
- K. Lee
We have described coronary sinus (CS) flow reversal (FR) during non-occlusive venography during CRT-D implantation. The incidence and effects of this phenomenon is unknown. This likely occurs due to dynamic changes in the Right Atrial pressure (RAp) and Coronary Sinus pressure (CSp) during the cardiac and respiratory cycle.
44 pts undergoing ICD implant (single, dual chamber or CRT) were enrolled. During implantation, Pulmonary Artery pressure (PAp), CSp and RAp were recorded simultaneously during inspiration and expiration. Pts were categorized in high PAp and low PAp groups (> 45 or ≤ 45 mm Hg Systolic). % time CS reversal (RAp >CSp) was obtained in 29/44 pts (66%) by measuring the time that RAp was greater than CSp divided by the respiratory cycle length.
We observed a trend towards increased CSp in pts with high PAp. CS Flow reversal was observed (RAp> CSp) during in 24/29 (83%) pts ranging from 3% to 100%.
|PA pressure ≤ 45 mmHg (n=24)||PA pressure > 45 mmHg (n=20)||P value|
|Gender||8 % Female||40 % Female||0.01|
|Systolic Pressure||117.5 ± 17.9 mmHg||126.9 ± 21.5 mmHg||0.1|
|Diastolic Pressure||70.3 ± 10.2 mmHg||71.1 ± 13.1 mmHg||0.8|
|Ischemic history||54 %||55 %||0.9|
|HF history||88 %||75 %||0.3|
|RA Pressure||14.1 10.4 mmHg||19.8 ± 8.1 mmHg||0.05|
|RV Pressure||34.6 ± 12.1 mmHg||60.1 ± 11.9 mmHg||<0.001|
|Aortic Pressure||98.3 ± 41.7 mmHg||121.6 ± 21.6 mmHg||0.03|
|CS Pressure||16.6 ± 7.8 mmHg||22.2 ± 9.1 mmHg||0.04|
|CS Flow Reversal||22.24% ± 28.1 %|
|36.11% ± 37.1 %|
CS-FR is common in heart failure patients undergoing ICD implantation. This may be a possible mechanism for interventricular interdependence and LV diastolic dysfunction in PHT.