Placement of the Coronary Sinus Catheter via the Right Cubital Vein During Atrial Fibrillation Ablation.

Background: Electrode catheter placement into the coronary sinus (CS) is critical for electrophysiologic studies. Although central venous approaches (e.g., internal jugular or subclavian) are well documented, peripheral venous approaches like the cubital vein are not. This study evaluated the feasibility and safety of CS catheter placement via the right cubital vein during atrial fibrillation (AF) ablation. Methods and Results: Of 1,363 consecutive patients who underwent first-time AF ablation at Sakurabashi Watanabe Advanced Healthcare Hospital between January 2019 and December 2021, 1,274 underwent at least 1 right cubital vein puncture attempt. The success rate, causes of failure, and complications were analyzed. CS catheters were successfully placed via the right cubital vein in 1,214 (95.3%) patients, whereas placements were unsuccessful in 60 (4.7%) patients. Although older patients were more likely to experience unsuccessful placements, there were no significant differences in other baseline characteristics between the 2 groups. Unsuccessful placements were attributed to failure in venipuncture or 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 demonstrated high feasibility and safety, with a 95% success rate and minimal complications. This approach offers a practical and technically straightforward alternative for placing CS catheters, particularly in patients with adequate vein development.