{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T09:11:18Z","timestamp":1779009078731,"version":"3.51.4"},"reference-count":6,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Anatomical variations of the coronary sinus (CS) may complicate left ventricular lead placement during cardiac resynchronization therapy (CRT). A rare variant, the double\u2010barrel coronary sinus, can result in inadvertent cannulation of non\u2010target tributaries and procedural difficulty.<\/jats:p>\n <\/jats:sec>\n \n Case Summary<\/jats:title>\n We report a 45\u2010year\u2010old woman with symptomatic heart failure, left bundle branch block (LBBB), severe left ventricular dysfunction, and left ventricular dyssynchrony who underwent CRT implantation. Levophase coronary angiography demonstrated a double\u2010barrel coronary sinus, with one channel continuing from the posterolateral vein and the other from the anterior interventricular vein. Repeated attempts to access the posterolateral vein preferentially entered the anterior interventricular vein. A modified pull\u2010back technique using a sheath and dual guidewires enabled successful cannulation of the posterolateral branch. Left ventricular lead placement was achieved, resulting in significant QRS narrowing and marked clinical improvement.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Recognition of double\u2010barrel coronary sinus anatomy and use of alternative wiring techniques can facilitate successful CRT implantation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70280","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T09:06:03Z","timestamp":1778576763000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Resynchronization Therapy Implantation in a Double\u2010Barrel Coronary Sinus"],"prefix":"10.1111","author":[{"given":"Suresh Kumar","family":"Sukumaran","sequence":"first","affiliation":[{"name":"Department of Cardiology Vadamalayan Hospitals Madurai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sasinthar","family":"Rangasamy","sequence":"additional","affiliation":[{"name":"Department of Cardiology Vadamalayan Hospitals Madurai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sathish Kumar","family":"Subbaraj","sequence":"additional","affiliation":[{"name":"Department of Cardiology Vadamalayan Hospitals Madurai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kannan","family":"BRJ","sequence":"additional","affiliation":[{"name":"Department of Cardiology Vadamalayan Hospitals Madurai India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.4067\/S0717-95022004000400016"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup270"},{"issue":"1","key":"e_1_2_12_4_1","first-page":"15","article-title":"10\u2010Year\u2010Cardiovascular Center Experience","volume":"94","author":"Plata\u2010Corona J. C.","year":"2024","journal-title":"Archivos de Cardiolog\u00eda de M\u00e9xico"},{"key":"e_1_2_12_5_1","first-page":"272","article-title":"Morphology of the Coronary Sinus and Contemporary Cardiac Electrophysiology","volume":"55","author":"Grzybiak M.","year":"1996","journal-title":"Folia Morphologica"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-023-02105-8"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.00897.x"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70280","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70280","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T09:05:58Z","timestamp":1779008758000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":6,"alternative-id":["10.1111\/pace.70280"],"URL":"https:\/\/doi.org\/10.1111\/pace.70280","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]},"assertion":[{"value":"2026-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70280"}}