Angiographic Anatomy of the Left Coronary Veins: Beyond Conventional Cardiac Resynchronization Therapy.

PURPOSE OF REVIEW: This review aims to synthesize current knowledge on the angiographic anatomy of the coronary sinus and its tributaries veins, with focus on venous branches other than classical ones used in cardiac resynchronization therapy. It also presents common anatomical aspects that could impact the clinical outcome.

RECENT FINDINGS: Recent advancements in the electrophysiology field, like epicardial arrhythmia mapping and ablation through coronary sinus or cardiac pacing from atypical veins requires a detailed angiographic assessment of cardiac veins. There is an increased interest for the veins coursing in the left ventricular summit (LVS) area and could potentially provide a pathway to reach the LVS arrhythmogenic foci. However, there is no consensus regarding the nomenclature and classification of these veins. This review could offer a better understanding of the coronary sinus and its tributary veins distribution, dimensions and relationship with nearby structures that could help the development of new ablation and pacing tools and strategies, with higher success rates.