Effectiveness and Safety of the Femoral Venous Approach for Coronary Sinus Catheterization in Children

Coronary sinus (CS) catheterization is widely used during electrophysiological studies (EPS) and catheter ablation. The femoral venous (FV) approach to CS catheterization for EPS has been reported in adults but not in children. We report our experience with CS catheter placement through the FV approach in children. The charts of children with normal hearts who underwent EPS with CS cannulation were reviewed. The FV approach was attempted followed by right internal jugular (IJ) vein approach, if unsuccessful. Between 2010 and 2015, 250 patients were studied with an average of 13 ± 3 years. The FV approach to CS catheterization was attempted in 249 patients and was successful in all but 13 (95% successful). The right IJ was used as the primary approach in 1 infant aged 6 weeks and as the backup approach in 11 of the 13 in whom the FV approach failed. There was no appreciable difference between ages of patients in whom FV versus IJ approaches were successful (13 years ± 3 vs 13 years ± 3, respectively). There were no complications from FV sheath placement or from placement of the CS catheter from the FV approach. The right IJ approach was complicated by carotid artery puncture without hematoma in 2 patients (18% of attempts). In conclusion, the FV approach is a safe and effective option for CS cannulation for EPS procedures in children. The IJ and other approaches could be used as back up when the FV approach fails.