After failing to advance the coronary sinus catheter into the right atria, a hydrophilic guidewire was employed to facilitate atrial advancement.
A bolus application of contrast media from the right femoral vein revealed an interruption in the upper segment of the vena cava.
Advancement of the first transseptal long sheath into the right atria over the hydrophilic guidewire.
The hydrophilic guidewire was initially directed to the right ventricular outflow for safe support during the advancement of the long sheath.
The coronary sinus catheter was retracted to the atria and repositioned at the right atrial appendage position because the operator encountered difficulty in directing the ablation catheter to Koch’s triangle due to the limited space between the two sheaths.