Figure legends
Figure1. Different approach for ablation catheter reaching target sites in DGCV. A. Manipulation of ablation catheter in GCV by non-Swartz sheath support (NS)approach. A1-A2. The tip of catheter was delivered to DGCV from the ostium of coronary sinus directly. B. Manipulation of ablation catheter in GCV by Swartz sheath support (SS)approach. B1-B2. The tip of catheter was delivered to summit-CV with the support from Swartz sheath in the GCV. C. Hydrophilic coated guide wire and left coronary angiographic catheter-guided deep engagement of Swartz sheath in GCV. C1. Due to the blockage of Vieussens valve (shown by coronary venography), even with the support of Swartz sheath, the catheter tip could not reach the middle part of GCV. C2. The hydrophilic coated guide wire and Judkin’s 4-left coronary catheter was delivered through Swartz sheath and passed the Vieussens valve and reached the DGCV. C3-C4. Guided by hydrophilic coated guide wire and Judkin’s catheter, the Swartz sheath was advanced alternately and passed the Vieussens valve, then the guidewire and Jukin’s catheter was exchanged with ablation catheter to performed mapping and ablation in DGCV. D. Schema of NS approach for DGCV-AIV VAs. Targeting DGCV-AIV VAs via advancing ablation catheter from ostium of coronary sinus directly. E. Schema of SS approach for DGCV-AIV VAs. Targeting DGCV-AIV VAs via advancing ablation catheter from ostium of coronary sinus with the support from Swartz sheath. LAD, left anterior descending artery, LCX, left circumflex artery. LAO, left anterior oblique, RAO, right anterior oblique.
Figure2.Anatomy of DGCV-AIV andanatomic obstacles preventing catheterization in GCV.A-C. Anatomy of DGCV-AIV. D-G. Anatomic obstacles preventing catheterization in GCV. D. Angle formed between DGCV and AIV, and an angle <83° prevented the ablation catheter advancing from DGCV into AIV with. E. Different morphology of GCV, and Width/Hight>0.69 more favored the application of SS approach. F. Venous valve (Vieussens valve) in GCV. G. Thin lumen of summit-CV. DGCV, distal great cardiac vein; AIV, anterior interventricular vein; summit-CV, communicating vein in left ventricular summit. RVOT, right ventricular outflow tract, LVOT, left ventricular outflow tract, TA, tricuspid annulus, MA, mitral annulus, CS, coronary sinus.