Snare technique for coronary sinus cannulation in cardiac resynchronization therapy

PURPOSE: Biventricular pacing is a mainstay of therapy for patients with heart failure. However, lead implantations may fail due to anatomical reasons including the impossibility of coronary sinus cannulation. METHODS AND RESULTS: A dual approach from the subclavian vein using a snare through a sheath and from the femoral vein using a steerable electrophysiology catheter was performed. Once the snare hooked the catheter, the latter was advanced into the coronary sinus and finally, the sheath could also be advanced in an “over-the-wire” technique. CONCLUSION: The snare technique for coronary sinus cannulation offers a “bail-out” strategy for left ventricular lead implantation.