Background: The placement of an electrode catheter into the coronary sinus (CS) is critical for electrophysiologic studies. While central venous approaches (e.g., internal jugular or subclavian) are well-documented, peripheral venous approaches like the cubital vein are not. This study aimed to evaluate the feasibility and safety of CS catheter placement via the right cubital vein during atrial fibrillation (AF) ablation. Methods: Of 1363 consecutive patients who underwent first-time AF ablation at our institution between January 2019 and December 2021, we investigated 1274 who had at least one attempt at right cubital vein puncture for CS catheter placement. We evaluated the success rate, causes of placement failures, and complications associated with the cubital vein approach. Results: The CS catheters were successfully placed via the right cubital vein in 1214 (95.3%) patients, while 60 (4.7%) had unsuccessful placements. While older patients were more likely to experience unsuccessful placements, there were no significant differences in other baseline characteristics. Unsuccessful placements were attributed to failure in venipuncture or 7 Fr sheath insertion (n = 49) and failure to advance the CS catheter through the vein (n = 11). No major complications were reported. Conclusions: CS catheter placement via the right cubital vein was generally safe with few adverse events and a success rate of approximately 95%. This approach offers a practical alternative for placing CS catheters, particularly in patients with adequate vein development.

Background: Few studies have explored the link between VISITAG SURPOINT (VS) parameters and the inter-tag distance (ITD) on pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation (AF). Objective: To examine the clinical outcomes and factors contributing to residual conduction and reconnection gaps during PVI. Methods and Results: A retrospective review of consecutive patients (N=100) with paroxysmal (n=32) or persistent AF (n=68) undergoing VS-guided ablation between 09/2018-08/2019 was performed. All procedures were performed by 2 operators. Target VS values were 425 (anterior), 375 (posterior), and 325 (in proximity of the esophagus). Target ITD was 4 mm. Acute PVI was achieved in 100% of cases, however 13 residual gaps in 12 patients were observed after the first encirclement (first pass isolation: 88%). Ten gaps due to spontaneous PV reconnections (PVR) were found in 9 patients (9%). Tags associated with these 23 gaps had similar median VS (gap-related vs. non-gap: 429 vs. 410, p=0.4545) and power (36 vs. 36W, p=0.4843), higher contact force (13.8 vs. 11.0g, p=0.0061), and larger ITD (5.3 vs. 3.7mm, p<0.001) when compared to the remaining tags. At median follow-up of 462 days (N=99 patients), freedom from any atrial arrhythmia was 84.8%. Eight patients received repeat ablation (8.1%) and of these, 6 (75%) were free from PVR. No major adverse events were noted. Conclusion: Favorable rates of first pass isolation, acute PVR, and long-term procedure success were achieved using lower VS values than in previous reports. Under these settings, larger ITDs are associated with residual conduction and reconnections.