Coronary sinus reducer implantation in the middle cardiac vein for the treatment of refractory angina

2019 ◽  
Vol 95 (4) ◽  
pp. 718-721 ◽  
Author(s):  
Gianpiero D'Amico ◽  
Mauro Massussi ◽  
Chiara Fraccaro ◽  
Giuseppe Tarantini
Keyword(s):  
Coronary Sinus ◽  
Refractory Angina ◽  
Middle Cardiac Vein

Coronary Sinus Reducer for the Treatment of Chronic Refractory Angina: Will This Challenge the Treatment of Coronary Chronic Total Occlusions?

2021 ◽  
Vol 23 (4) ◽  
Author(s):  
Giovanni Maria Vescovo ◽  
Carlo Zivelonghi ◽  
Michele Bellamoli ◽  
Paul Vermeersch ◽  
Stefan Verheye ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Refractory Angina ◽  
Chronic Total Occlusions

scholarly journals Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina

2015 ◽  
Vol 372 (6) ◽  
pp. 519-527 ◽  
Author(s):  
Stefan Verheye ◽  
E. Marc Jolicœur ◽  
Miles W. Behan ◽  
Thomas Pettersson ◽  
Paul Sainsbury ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Refractory Angina

Effects of coronary sinus Reducer implantation on oxygen kinetics in patients with refractory angina

2021 ◽  
Vol 16 (18) ◽  
pp. e1511-e1517
Author(s):  
Carlo Zivelonghi ◽  
Maayan Konigstein ◽  
Alessia Azzano ◽  
Pierfrancesco Agostoni ◽  
Yan Topilski ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Refractory Angina ◽  
Oxygen Kinetics

Coronary sinus reducer therapy for refractory angina: is it ready for prime time?

2021 ◽  
Vol 17 (7) ◽  
pp. 530-531
Author(s):  
Michael Foley ◽  
Rasha K. Al-Lamee
Keyword(s):  
Coronary Sinus ◽  
Prime Time ◽  
Refractory Angina

Coronary Sinus Reducer: A Solution for patients with Refractory Angina

2021 ◽  
pp. 101085
Author(s):  
Sugeevan Savarimuthu ◽  
Bejoy Philip ◽  
Amer Harky
Keyword(s):  
Coronary Sinus ◽  
Refractory Angina

scholarly journals Real world experience with coronary sinus reducer implantation for the treatment of refractory angina: a single-centre experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
R Ramos ◽  
P Rio ◽  
A Fiarresga ◽  
D Cacela ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Real World ◽  
Therapeutic Option ◽  
Objective Evaluation ◽  
Short Version ◽  
Refractory Angina ◽  
Single Centre ◽  
Real World Data ◽  
Serious Adverse Events

Abstract Background Coronary sinus Reducer device (CSF) implantation is a novel therapeutic option to relieve symptoms in patients with refractory angina (RA). There is limited real-world data describing its use outside of clinical trials. Aim To assess the safety and efficacy of this procedure in a real-world setting. Methods This is a report of a single centre prospective registry of consecutive patients with RA (CCS II-IV) deemed unsuitable for revascularization. Between May 2017 and August 2019, 17 patients were referred to CSF implantation. Baseline and follow-up evaluation consisted of clinical assessment, including completion of the short version of the Seattle Angina Questionnaire (SAQ-7) and CCS class evaluation and objective evaluation by transthoracic echocardiography and cardiopulmonary exercise test (CPET). Results A total of 13 patients (70,6±6,5 years, 76,9% male) underwent CSF implantation with a procedural success of 84.6%. No cases of periprocedural serious adverse events were reported. At 12-month follow-up, any reduction in CCS Class was achieved in 72.7% of cases, with 27.2% reducing 2 CCS classes. Baseline CCS score was reduced from 2.8±0.4 to 1.7±0.8 (p=0.009). Quality of life (QoL) was significantly improved as assessed by the improvement seen in all items of SAQ-7 (p<0.017 for all). CPET duration was significantly increased (p=0.034), but no change was noted in the remainder CPET variables. During follow-up, 3 patients suffered myocardial infarction, resulting in 1 death. Conclusion CSF implantation in patients with RA was safe and led to a significant reduction of the angina burden and improvement of QoL at 12-month follow-up. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 5690: Idiopathic Catecholamine-sensitive Epicardial Ventricular Tachycardia At The Crux Of The Heart

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Harish Doppalapudi ◽  
Karthik Ramaswamy ◽  
Joon Ahn ◽  
Takumi Yamada ◽  
G Neal Kay
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Coronary Sinus ◽  
Clinical Syndrome ◽  
Epicardial Surface ◽  
Surface Ecg ◽  
Coronary Venous System ◽  
The Right ◽  
Mean Cycle ◽  
Middle Cardiac Vein

Idiopathic ventricular tachycardia (VT) has been described from the epicardial surface of the left ventricle (LV), usually near the summit of the LV in the outflow tract. Ablation of these VTs may be possible by delivery of energy within the coronary venous system or directly on the epicardial surface. We describe a distinct syndrome of focal epicardial VT induced by catecholamine infusion that arises from the crux of the heart. Among 340 cases of idiopathic VT referred for catheter ablation, 4 patients were identified with a clinical syndrome of catecholamine sensitive VT that was mapped to the epicardial surface at the crux of the heart. There were 3 males and 1 female (age 31–79 yrs, mean 58). VT was sustained in all patients and associated with syncope or near syncope in 3 of 4 pts. The LVEF was >0.55 in 3 pts and mildly depressed (0.45) in 1 pt. In all pts VT could be induced with programmed stimulation or burst pacing from the right ventricular apex but required the infusion of isoproterenol for induction in 3. The VT was very rapid with a mean cycle length of 264 msec. The surface ECG during VT demonstrated a left superior axis QRS morphology in all pts, with an abrupt precordial tansition from V1 to V2 in 3 pts and R waves across the precordium in one. The precordial maximal deflection index was > 0.55 in all pts (mean 0.67). The site of earliest activation during intracardiac mapping occurred at the crux of the heart with activation in the middle cardiac vein or proximal coronary sinus recorded 20 –50 msec (mean −38 msec) prior to the onset of the surface QRS. Catheter ablation with irrigated RF was attempted within the middle cardiac vein or proximal coronary sinus in all pts and was successful in 1. In 2 of 3 remaining pts, percutaneous epicardial RF ablation was attempted and was successful. Simultaneous coronary angiography demonstrated the site of earliest activation within 5–10 mm of the proximal posterior descending coronary artery (PDA). There was no acute narrowing of the PDA in any pt following ablation. Idiopathic VT may arise from the epicardial surface at the crux of the heart in close proximity to the PDA. This syndrome can result in very rapid, catecholamine sensitive VT, and may require careful attention to the PDA during ablation.

scholarly journals A novel method to interpret early phase trials shows how the narrowing of the coronary sinus concordantly improves symptoms, functional status and quality of life in refractory angina

Heart ◽  
2020 ◽  
Vol 107 (1) ◽  
pp. 41-46
Author(s):  
E Marc Jolicoeur ◽  
Stefan Verheye ◽  
Timothy D Henry ◽  
Lawrence Joseph ◽  
Serge Doucet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Sinus ◽  
Early Phase ◽  
Exercise Duration ◽  
Control Group ◽  
Refractory Angina ◽  
Group Level ◽  
Early Phase Trials ◽  
Level Analysis

BackgroundReduction of the coronary sinus was shown to improve angina in patients unsuitable for revascularisation. We assessed whether a percutaneous device that reduces the diameter of the coronary sinus improved outcomes across multiple endpoints in a phase II trial.MethodsWe conducted a novel analysis performed as a post hoc efficacy analysis of the COSIRA (Coronary Sinus Reducer for Treatment of Refractory Angina) trial, which enrolled patients with Canadian Cardiovascular Society (CCS) class 3–4 refractory angina. We used four domains: symptoms (CCS Angina Scale), functionality (total exercise duration), ischaemia (imaging) and health-related quality of life. For all domains, we specified a meaningful threshold for change. The primary endpoint was defined as a probability of ≥80% that the reducer exceeded the meaningful threshold on two or more domains (group-level analysis) or that the average efficacy score in the reducer group exceeded the sham control group by at least two points (patient-level analysis).ResultsWe randomised 104 participants to either a device that narrows to coronary sinus (n=52) or a sham implantation (n=52). The reducer group met the prespecified criteria for concordance at the group level and demonstrated improvement in symptoms (0.59 CCS grade, 95% credible interval (CrI)=0.22 to 0.95), total exercise duration (+27.9%, 95% CrI=2.8% to 59.8%) and quality of life (stability +11.2 points, 95% CrI=3.3 to 19.1; perception +11.0, 95% CrI=3.3 to 18.7).ConclusionsThe reducer concordantly improved symptoms, functionality and quality of life compared with a sham intervention in patients with angina unsuitable for coronary revascularisation. Concordant analysis such as this one can help interpret early phase trials and guide the decision to pursue a clinical programme into a larger confirmatory trial.Trail registration numberClinicalTrials.gov identifier: NCT01205893.

Sign in / Sign up

Export Citation Format

Share Document