Procedure-related Complication
In general, procedure-related complications in CRT implantations are more frequently observed in female patients with CRT-D, mostly attributable to pneumothorax, pericardial tamponade, and CS dissection (15). The incidence rate of CS dissection has been reported as ranging from 1.4 to 6.8% (15,16), which may be caused by inadequate cannulation to a CS branch, presence of intravascular obstructions, aggressive manipulation of a guiding sheath, tortuous vessels, or unusual anatomy (16). In the current study, procedure-related complications, especially mechanical injuries of the CS were significantly less in the Inner-Cath group. The use of Inner-Cath for CS cannulation, especially guided by an EP catheter, may prevent risk of mechanical injuries of the CS trunk and tributaries due to the manipulation of guiding catheters.