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Guo M, Zhang N, Jia G, Ma G, Li X, Wang R. A rare focal atrial tachycardia arising from the proximal middle cardiac vein: a case report. BMC Cardiovasc Disord 2023; 23:169. [PMID: 36991334 PMCID: PMC10061710 DOI: 10.1186/s12872-023-03172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Focal atrial tachycardia (FAT) always originates from atrium specific sites and can be successfully cured by radiofrequency (RF) ablation. However, the middle cardiac vein (MCV) is a rare site of focal atrial tachycardia. Herein, we present a case of a 20-year-old young woman with FAT. Electrophysiological examination showed FAT arising from the proximal middle cardiac vein (pMCV), and successful RF ablation was applied with a low power and short-ablation. CASE PRESENTATION A 20-year-old woman with no structural heart disease suffered recurrent supraventricular tachycardia for 1 year. Physical examination, laboratory studies and the echocardiography results of this patient were normal. A 12-lead electrocardiogram (ECG) showed a narrow QRS and long RP tachycardia which was always triggered by a sinus rhythm. The patient underwent an electrophysiological study and found the earliest activation was in the proximal MCV (pMCV). After a low power and short-ablation, AT was terminated and noninducible by programmed pacing with or without isoproterenol infusion. CONCLUSION This case presented a rare case of FAT arising from the pMCV. We demonstrate that low power and short-ablation are effective in AT arising from specific areas such as the coronary sinus ostium and pMCV.
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Affiliation(s)
- Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Gao Jia
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Guijin Ma
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Xin Li
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, No.85 Jiefang Road, Taiyuan, 030001, Shanxi, China.
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10-year single center experience of catheter ablation of focal atrial tachycardia. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01416-5. [DOI: 10.1007/s10840-022-01416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
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Guan F, Duru F, Gass M, Wolber T. Focal atrial tachycardia originating from mirror position of fossa ovalis: A case report. HeartRhythm Case Rep 2022; 8:151-154. [PMID: 35492835 PMCID: PMC9039558 DOI: 10.1016/j.hrcr.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fu Guan
- Arrhythmia and Electrophysiology Division, Department of Cardiology, University Heart Center, Zurich, Switzerland
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Firat Duru
- Arrhythmia and Electrophysiology Division, Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Matthias Gass
- Children’s Research Center, University Children’s Hospital, Zurich, Switzerland
| | - Thomas Wolber
- Arrhythmia and Electrophysiology Division, Department of Cardiology, University Heart Center, Zurich, Switzerland
- Address reprint requests and correspondence: Dr Thomas Wolber, Arrhythmia and Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Chaumont C, Saoudi N, Savouré A, Lațcu DG, Anselme F. Electrophysiologic evidence of epicardial connections between low right atrium and remote right atrial region or coronary sinus musculature: Relevance for catheter ablation of typical atrial flutter. J Cardiovasc Electrophysiol 2020; 31:2344-2351. [PMID: 32562446 DOI: 10.1111/jce.14627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The coronary sinus (CS) is surrounded by a myocardial coat with extensive connections to the left and right atria that contributes to the interatrial electrical connection. Whereas epicardial connections between CS musculature and the left atrium have largely been demonstrated, clinically relevant epicardial connections from the CS musculature toward the low right atrium (LRA) and epicardial connections between two regions of the right atrium remain questionable. METHODS Five patients underwent electrophysiology (EP) study for typical atrial flutter (AFl) using either conventional multipolar catheters (four patients) or three-dimensional high-density mapping system (one patient). RESULTS All five patients had a similar sequence of events during the EP studies. After several cavotricuspid isthmus (CTI) radiofrequency (RF) applications, double potentials were recorded along the ablation line while tachycardia persisted. The right atrial activation pattern strongly suggested the presence of a complete endocardial CTI line of the block. Based on the detailed conventional atrial mapping, RF applications at the middle cardiac vein/CS ostium allowed sinus rhythm restoration in four patients. High-density mapping showed an early breakthrough site at the septal side of the ablation line, close to the CS ostium during counterclockwise AFl, in the fifth patient. RF applications at this site resulted in tachycardia termination. CONCLUSION Our observations suggested the existence of epicardial fibers connecting the LRA with either the CS musculature or a remote right atrial region. When AFl ablation fails whereas evidence for the local endocardial block is observed, the operators should integrate this finding in the diagnosis and ablation strategy.
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Affiliation(s)
| | - Nadir Saoudi
- Department of Cardiology, Princess Grace Hospital, Monaco
| | - Arnaud Savouré
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | | | - Frédéric Anselme
- Department of Cardiology, Rouen University Hospital, Rouen, France
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Derval N, Takigawa M, Frontera A, Mahida S, Konstantinos V, Denis A, Duchateau J, Pillois X, Yamashita S, Berte B, Thompson N, Hooks D, Pambrun T, Sacher F, Hocini M, Bordachar P, Jaïs P, Haïssaguerre M. Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping. JACC Clin Electrophysiol 2020; 6:815-826. [DOI: 10.1016/j.jacep.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
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Sicouri S, Belardinelli L, Antzelevitch C. Effect of autonomic influences to induce triggered activity in muscular sleeves extending into the coronary sinus of the canine heart and its suppression by ranolazine. J Cardiovasc Electrophysiol 2018; 30:230-238. [PMID: 30302862 DOI: 10.1111/jce.13770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Extrasystoles arising from the muscular sleeves associated with the pulmonary veins (PV), superior vena cava (SVC), and coronary sinus (CS) are known to precipitate atrial fibrillation (AF). The late sodium channel current (INa ) inhibitor ranolazine has been reported to exert antiarrhythmic effects in canine PV and SVC sleeves by suppressing late phase 3 early and delayed after depolarization (EAD and DAD)-induced triggered activity induced by parasympathetic and/or sympathetic stimulation. The current study was designed to extend our existing knowledge of the electrophysiological and pharmacologic properties of canine CS preparations and assess their response to inhibition of late INa following autonomic stimulation. METHODS Transmembrane action potentials were recorded from canine superfused CS using standard microelectrode techniques. Acetylcholine (ACh, 1 µM), isoproterenol (Iso, 1 µM), high calcium ([Ca2+ ]o = 5.4 mM), or a combination were used to induce EADs, DADs, and triggered activity. RESULTS Action potentials (AP) recorded from the CS displayed short and long AP durations (APD), with and without phase 4 depolarization (n = 19). Iso induced DAD-mediated triggered activity. The combination of sympathetic and parasympathetic agonists resulted in late phase 3 EAD-induced triggered activity in all CS preparations. Ranolazine (5-10 µM) suppressed late phase 3 EAD- and DAD-induced triggered activity in 8 of 8 preparations. Subthreshold stimulation induced a prominent hyperpolarization that could be suppressed by atropine. CONCLUSIONS Our results suggest the important role of parasympathetic innervation in the activity of the CS. Autonomic influences promote DAD- and late phase-3-EAD-mediated triggered activity in canine CS, thus generating extrasystolic activity capable of initiating atrial arrhythmias. Ranolazine effectively suppresses these triggers.
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Affiliation(s)
- Serge Sicouri
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, Utica, New York.,Cardiovascular Research Program, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Charles Antzelevitch
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, Utica, New York.,Cardiovascular Research Program, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.,Lankenau Heart Institute, Wynnewood, Pennsylvania.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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De Sisti A, Andronache M, Damiano P, Eschalier R, Font M. Is proximal coronary sinus involved in the circuit in some cases of ECG "typical" atrial flutter? J Cardiovasc Electrophysiol 2018; 29:1508-1514. [PMID: 30080278 DOI: 10.1111/jce.13703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Abstract
AIM It is commonly conceived that coronary sinus (CS) participates in atrial flutter (AFL) circuit but limited to the fibers surrounding its ostium. We evaluated the involvement of proximal CS in typical AFL. METHODS Twenty AFL patients underwent entrainment mapping using postpacing interval minus AFL cycle length (PPI-AFL CL) including CS where a decapolar catheter was positioned with proximal bipole 1 cm from the ostium. RESULTS We compared patients with proximal CS within the circuit (group 1, PPI-AFL CL ≤ 20 ms + concealed entrainment) and those without (group 2, PPI-AFL CL > 20 ms). Group 1 patients were older, 77.5 ± 4 vs 71 ± 12 years (P < 0.05). No difference was found in AFL CL, PPI-AFL CL at cavotricuspid isthmus (CTI) entry, plateau, and septal site. Group 1 patients had shorter PPI-AFL CL at proximal CS (9 ± 3 vs 40 ± 15 ms; P < 0.001) and fragmented mesodiastolic CS atrial potentials (APs) (106 ± 27 vs 58.5 ± 22 ms; P < 0.001). A mid-septal unexcitable scar was found in five of eight group 1 patients vs one of 12 group 2 patients (P < 0.05). All were ablated at CTI. A patient had AFL recurrence and underwent a second attempt: PPI-AFL CL was 60 ms at CTI entry and less than or equal to 20 ms at septal CTI and proximal CS; AFL was terminated 1 cm inside CS, applying RF at a fragmented AP. CONCLUSION Proximal CS appears to be involved in a substantial subset of typical AFL patients, in whom advanced age, fragmented CS APs, and the presence of right atrial scar are prevalent. Proximal CS might be considered as an un-"innocent by-stander," but able, in rare cases, to generate a second AFL circuit.
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Affiliation(s)
- Antonio De Sisti
- Rhythmology Unit, Cardiology Department, Henry Mondor Hospital, Aurillac, France
| | - Marius Andronache
- Rhythmology Unit, Cardiology Department, University Hospital Center, Clermont-Ferrand, France
| | - Pamela Damiano
- Rhythmology Unit, Cardiology Department, Henry Mondor Hospital, Aurillac, France
| | - Roman Eschalier
- Rhythmology Unit, Cardiology Department, University Hospital Center, Clermont-Ferrand, France
| | - Manuel Font
- Rhythmology Unit, Cardiology Department, Henry Mondor Hospital, Aurillac, France
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8
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Allam LE, Ahmed RS, Ghanem MT. Role of surface electrocardiogram precordial leads in localizing different anatomic sites of ectopic atrial tachycardia arising from lower right atrium in pediatric population. Ann Noninvasive Electrocardiol 2017; 23. [PMID: 28833997 DOI: 10.1111/anec.12485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/16/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The study was designed to examine P wave morphology (PWM) in precordial leads (V1 -V6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. METHODS Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. RESULTS Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V3 -V6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. CONCLUSIONS P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs.
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Knecht S, Spies F, Altmann D, Reichlin T, Sticherling C, Kühne M. Electroanatomic mapping of atrial tachycardia-Manual vs automated annotation. HeartRhythm Case Rep 2016; 3:145-147. [PMID: 28491790 PMCID: PMC5420056 DOI: 10.1016/j.hrcr.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | | | - Tobias Reichlin
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.,CRIB - Cardiovascular Research Institute Basel, Basel, Switzerland
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Yazaki K, Enta K, Kataoka S, Kahata M, Kumagai A, Inoue K, Koganei H, Otsuka M, Ishii Y. Interesting electrophysiological findings in a patient with coexistence of atrial tachycardia originating from coronary sinus and slow-fast atrioventricular nodal reentrant tachycardia. J Cardiol Cases 2016; 15:80-83. [PMID: 30279745 DOI: 10.1016/j.jccase.2016.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022] Open
Abstract
Slow-fast atrioventricular nodal tachycardia (AVNRT) has various electrophysiological aspects due to atrioventricular (AV) nodal physiology. In addition, concomitantly another form of arrhythmia with AVNRT, especially atrial tachycardia (AT), was an infrequent arrhythmia. A 38-year-old female with narrow QRS tachycardia underwent electrophysiological study due to frequent faintness. The electrophysiological study disclosed the coexistence of AT originating from coronary sinus (CS) with slow-fast AVNRT. We easily diagnosed AT originating from CS and terminated with several radiofrequency ablations (RFA) around CS. The diagnosis of slow-fast AVNRT, however, was somewhat difficult due to the following findings: (1) small amount of adenosine triphosphate (ATP) could terminate slow-fast AVNRT reproducibly; (2) we could provoke slow-fast AVNRT only by RV pacing with isoproterenol infusion. With other electrophysiological findings, we diagnosed slow-fast AVNRT. Radiofrequency energy was delivered initially in the posteroseptal region, followed by inside CS, and finally in the middle septal region, which completed the slow pathway ablation. After the procedure, we could never provoke these arrhythmias. <Learning objective: Coexistence of focal AT originating from CS with slow-fast AVNRT is a rare phenomenon. Furthermore, slow-fast AVNRT could show unusual characteristic as following: (1) small amount of ATP terminates slow-fast AVNRT; (2) atrial pacing never provoked slow-fast AVNRT with isoproterenol infusion whereas ventricular pacing did, which depends on the physiological characteristic of the dual AV nodal pathway. Accordingly, we should precisely assess the obtained electrophysiological findings.>.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Kenji Enta
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Shohei Kataoka
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Mitsuru Kahata
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Asako Kumagai
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Koji Inoue
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Hiroshi Koganei
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Masato Otsuka
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
| | - Yasuhiro Ishii
- Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan
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Kaneshiro T, Yoshida K, Sekiguchi Y, Tada H, Kuroki K, Kuga K, Kamiyama Y, Suzuki H, Takeishi Y, Aonuma K. Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter. J Arrhythm 2016; 33:86-91. [PMID: 28416972 PMCID: PMC5388043 DOI: 10.1016/j.joa.2016.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022] Open
Abstract
Background Several studies reported that cavotricuspid isthmus-dependent atrial flutter (typical AFL) frequently coexists with atrial fibrillation (AF); however, the underlying mechanisms have not been fully investigated. This study aimed to reveal the mechanisms of the initiation of typical AFL and the association between typical AFL and AF. Methods Among 154 consecutive patients undergoing a first catheter ablation of AF, we investigated the appearance and mechanism of spontaneous initiation of typical AFL during catheter ablation. Then, we retrospectively investigated 67 consecutive patients without a previous AF episode who underwent typical AFL ablation. The occurrence and predictors of AF after catheter ablation were evaluated. Results During AF ablation, spontaneous initiation of typical AFL occurred during sinus rhythm in eight (5.2%) patients. The initiations of typical AFL were pulmonary vein (PV) firings except in one patient, in whom paroxysmal AF following superior vena cava firing initiated reverse typical AFL after PV isolation. After typical AFL ablation, AF occurred in 23 (34.3%) patients (mean follow up, 28.2±20.3 months). Kaplan-Meier analysis showed the occurrence of AF after typical AFL ablation to be significantly higher in the patients with a larger left atrial diameter over 40 mm (log-rank test, P=0.046). Conclusions PV firing through AF played an important role in initiating typical AFL. The occurrence of AF after typical AFL ablation was high, and a dilated left atrium was associated with increased occurrence of AF. These findings disclosed the close relationship between typical AFL and AF, especially PV firing.
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Affiliation(s)
- Takashi Kaneshiro
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kentaro Yoshida
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Eiheiji-Cho, Japan
| | - Kenji Kuroki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Kuga
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kamiyama
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Traykov VB. Mapping strategies in focal atrial tachycardias demonstrating early septal activation: distinguishing left from right. Curr Cardiol Rev 2015; 11:111-7. [PMID: 25308813 PMCID: PMC4356717 DOI: 10.2174/1573403x10666141013121428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 04/05/2014] [Indexed: 11/29/2022] Open
Abstract
Determining the chamber of origin of focal atrial tachycardias (FATs) arising at or close to the septum might require biatrial mapping. This review focuses on the available tools and methods used to distinguish right atrial from left atrial origin before left atrial access is obtained. These include analysis of P wave morphology, assessing the timing of right atrial septal activation, the sequence of right atrial and/or biatrial activation and analysis of earliest electrogram morphology. The electroanatomical properties of the interatrial septum and coronary sinus that provide the basis for the above mentioned tools have also been briefly described.
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Affiliation(s)
- Vassil B Traykov
- Clinic of Cardiology, Tokuda Hospital - Sofia, N.Vaptzarov blvd. 51B, 1407 Sofia, Bulgaria.
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13
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Buttà C, Tuttolomondo A, Giarrusso L, Pinto A. Electrocardiographic diagnosis of atrial tachycardia: classification, P-wave morphology, and differential diagnosis with other supraventricular tachycardias. Ann Noninvasive Electrocardiol 2015; 20:314-27. [PMID: 25530184 PMCID: PMC6931826 DOI: 10.1111/anec.12246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Atrial tachycardia is defined as a regular atrial activation from atrial areas with centrifugal spread, caused by enhanced automaticity, triggered activity or microreentry. New ECG classification differentiates between focal and macroreentrant atrial tachycardia. Macroreentrant atrial tachycardias include typical atrial flutter and other well characterized macroreentrant circuits in right and left atrium. Typical atrial flutter has been described as counterclockwise reentry within right atrial and it presents a characteristic ECG "sawtooth" pattern on the inferior leads. The foci responsible for focal atrial tachycardia do not occur randomly throughout the atria but tend to cluster at characteristic anatomical locations. The surface ECG is a very helpful tool in directing mapping to particular areas of interest. Atrial tachycardia should be differentiated from other supraventricular tachycardias. We propose a diagnostic algorithm in order to help the physician to discriminate among those. Holter analysis could offer further details to differentiate between atrial tachycardia and another supraventricular tachycardia. However, if the diagnosis is uncertain, it is possible to utilize vagal maneuvers or adenosine administration. In conclusion, in spite of well-known limits, a good interpretation of ECG is very important and it could help the physician to manage and to treat correctly patients with atrial tachycardia.
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Affiliation(s)
- Carmelo Buttà
- U.O.C. Internal Medicine and Cardioangiology, Biomedical Department of Internal and Specialist Medicine, University of Palermo, PalermoItaly
| | - Antonino Tuttolomondo
- U.O.C. Internal Medicine and Cardioangiology, Biomedical Department of Internal and Specialist Medicine, University of Palermo, PalermoItaly
| | - Lucia Giarrusso
- U.O.C. Internal Medicine and Cardioangiology, Biomedical Department of Internal and Specialist Medicine, University of Palermo, PalermoItaly
| | - Antonio Pinto
- U.O.C. Internal Medicine and Cardioangiology, Biomedical Department of Internal and Specialist Medicine, University of Palermo, PalermoItaly
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Morita H, Zipes DP, Morita ST, Wu J. Isolation of Canine Coronary Sinus Musculature From the Atria by Radiofrequency Catheter Ablation Prevents Induction of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2014; 7:1181-8. [DOI: 10.1161/circep.114.001578] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroshi Morita
- From the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis (H.M., D.P.Z., S.T.M., J.W.); Department of Cardiovascular Therapeutics/Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan (H.M., S.T.M.); and Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown (J.W.)
| | - Douglas P. Zipes
- From the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis (H.M., D.P.Z., S.T.M., J.W.); Department of Cardiovascular Therapeutics/Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan (H.M., S.T.M.); and Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown (J.W.)
| | - Shiho T. Morita
- From the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis (H.M., D.P.Z., S.T.M., J.W.); Department of Cardiovascular Therapeutics/Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan (H.M., S.T.M.); and Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown (J.W.)
| | - Jiashin Wu
- From the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis (H.M., D.P.Z., S.T.M., J.W.); Department of Cardiovascular Therapeutics/Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan (H.M., S.T.M.); and Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown (J.W.)
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Beukema RJ, Smit JJJ, Adiyaman A, Van Casteren L, Delnoy PPH, Ramdat Misier AR, Elvan A. Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature. ACTA ACUST UNITED AC 2014; 17:953-61. [DOI: 10.1093/europace/euu227] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/31/2014] [Indexed: 11/12/2022]
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16
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Katsouras G, Dubuc M, Khairy P. Transcatheter mapping and ablation of arrhythmias in the coronary sinus. Expert Rev Cardiovasc Ther 2014; 4:711-20. [PMID: 17081093 DOI: 10.1586/14779072.4.5.711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The coronary sinus (CS) is a complex structure of particular interest to cardiac electrophysiologists. It is exploited as an anatomical reference, a site to record left-sided atrial and ventricular signals and for cardiac resynchronization therapy. Perhaps less appreciated, it may itself serve as a substrate for arrhythmias. It is now increasingly recognized that arrhythmias may be targeted by transcatheter ablation within the CS. This review summarizes pertinent anatomic considerations, explores the relationship between the CS and various arrhythmia substrates, elaborates on current indications for intra CS ablation and addresses efficacy and safety concerns associated with transcatheter ablation.
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Affiliation(s)
- Grigorios Katsouras
- Montreal Heart Institute, Electrophysiology and Adult Congenital Heart Disease, 5000 Belanger St E., Montreal, QC H1T 1C8, Canada
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17
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Reentry mechanisms and ablation of ECG-typical atrial flutters involving the cavo-tricuspid isthmus and the proximal coronary sinus. Int J Cardiol 2013; 168:3728-35. [DOI: 10.1016/j.ijcard.2013.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 04/12/2013] [Accepted: 06/15/2013] [Indexed: 11/16/2022]
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18
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Noheria A, DeSimone CV, Lachman N, Edwards WD, Gami AS, Maleszewski JJ, Friedman PA, Munger TM, Hammill SC, Hayes DL, Packer DL, Asirvatham SJ. Anatomy of the coronary sinus and epicardial coronary venous system in 620 hearts: an electrophysiology perspective. J Cardiovasc Electrophysiol 2012; 24:1-6. [PMID: 23066703 DOI: 10.1111/j.1540-8167.2012.02443.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cannulation of the coronary sinus (CS) is a prerequisite for left ventricular (LV) pacing and certain ablation procedures. The detailed regional anatomy for the coronary veins and potential anatomic causes for difficulty with these procedures has not been established. METHODS AND RESULTS Therefore, we performed macroscopic measurements in 620 autopsied hearts (mean age 60 ± 23 years, 44% female). The CS was preserved for analysis in 96%. Sixty-three percent had a Thebesian valve that covered the posterior aspect of the CS ostium with extension to the superior (50%) and inferior aspects (18%) and was obstructive with fenestrations in 3 specimens. Partial or near occlusive valves were present occasionally at the ostium of the great cardiac vein (Vieussens; 8%) and middle cardiac vein (5%). Ninety-three percent had left atrial branches, and 41% had at least one branch with lumen > 3 French. For CRT lead placement, the mid-lateral LV was accessible from the middle cardiac vein (20%), the left posterior vein (92%) or the anterior interventricular vein (86%). Among specimens where the left phrenic nerve was preserved it crossed the LV mid-lateral wall in 45%. CONCLUSIONS Epicardial coronary vein anatomy is variable, and the mid-lateral LV wall can potentially be accessed through various tributaries of the epicardial veins. The orientation of the Thebesian valve favors cannulation of the CS from an anterior (ventricular) and inferior approach. Anterobasal, mid-lateral, and inferior apical LV coronary veins lie in proximity to the course of the phrenic nerve.
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Affiliation(s)
- Amit Noheria
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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KHAN MOHSINK, ELMOUCHI DARRYL. Ablation of a Resistant Right Atrial Appendage Tachycardia Using a Magnetic Navigation System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:e15-8. [DOI: 10.1111/j.1540-8159.2012.03389.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/21/2011] [Accepted: 12/03/2011] [Indexed: 11/30/2022]
Affiliation(s)
- MOHSIN K. KHAN
- Department of Internal Medicine; Grand Rapids Medical Education Partners (GRMEP)/Michigan State University; Grand Rapids; Michigan
| | - DARRYL ELMOUCHI
- Department of Clinical Cardiac Electrophysiology; West Michigan Heart/Spectrum Health; Michigan State College of Human Medicine; Grand Rapids; Michigan
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Traykov VB, Pap R, Shalganov TN, Bencsik G, Makai A, Gallardo R, Klausz G, Forster T, Saghy L. Electrogram analysis at the His bundle region and the proximal coronary sinus as a tool to predict left atrial origin of focal atrial tachycardias. Europace 2011; 13:1022-1027. [DOI: 10.1093/europace/eur077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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21
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Iwai S, Badhwar N, Markowitz SM, Stambler BS, Keung E, Lee RJ, Chung JH, Olgin JE, Scheinman MM, Lerman BB. Electrophysiologic properties of para-Hisian atrial tachycardia. Heart Rhythm 2011; 8:1245-53. [PMID: 21397044 DOI: 10.1016/j.hrthm.2011.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/06/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Focal atrial tachycardia (AT) originates from preferential sites, including the tricuspid and mitral annuli. AT arising from the atrioventricular annuli is initiated and terminated with programmed stimulation and is, in general, adenosine and verapamil sensitive. Para-Hisian AT arising from the apex of the triangle of Koch has been considered to be a distinct entity, characterized by unique electrophysiological properties. OBJECTIVE We sought to more fully delineate the electrophysiological and electrocardiographic properties of para-Hisian AT in a large series of patients. METHODS The study population consisted of 38 patients (63 ± 15 years; 23 female) with AT from the para-Hisian region. The ATs were focal and originated from the anteroseptal tricuspid annulus, in close proximity to the His bundle recording. Proximity to the His bundle was confirmed by electrogram recordings, fluoroscopy, and centrifugal activation during three-dimensional mapping. RESULTS The mean AT cycle length was 421 ± 69 ms. AT was associated with a distinct P-wave morphology that was significantly narrower than the P wave during sinus rhythm. Adenosine (5.0 ± 1.5 mg) terminated AT in 34/35 patients. Intravenous verapamil terminated AT in three of three patients. Catheter ablation was attempted in 30 patients and was successful in 26 (87%). CONCLUSION The para-Hisian region is a source of focal AT, with properties consistent with AT arising circumferentially along the tricuspid and mitral annuli, and should be considered a subset of this broader group of "annular" ATs. The electropharmacologic findings in para-Hisian AT are mechanistically consistent with cyclic AMP-mediated triggered activity.
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Affiliation(s)
- Sei Iwai
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA
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22
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QIAN ZHIYONG, HOU XIAOFENG, XU DONGJIE, YANG BING, CHEN MINGLONG, CHEN CHUN, ZHANG FENGXIANG, SHAN QIJUN, CAO KEJIANG, ZOU JIANGANG. An Algorithm to Predict the Site of Origin of Focal Atrial Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:414-21. [DOI: 10.1111/j.1540-8159.2010.02980.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Interventional bronchoscopy from bench to bedside: new techniques for central and peripheral airway obstruction. Clin Chest Med 2010; 31:101-15, Table of Contents. [PMID: 20172436 DOI: 10.1016/j.ccm.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article discusses how basic scientific concepts, based on a greater understanding of airway physiology, support the development and dissemination of multidimensional classification systems for tracheal stenosis, expiratory central airway collapse, and innovative interventional bronchoscopic procedures for patients with asthma and chronic obstructive pulmonary disease.
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24
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Fukuda T, Haruna T, Ito H, Sasaki K, Abe T, Nakane E, Miyamoto S, Uehara K, Ooba M, Ueyama K, Inoko M, Nohara R. AV Nodal Reentrant Tachycardia in a Patient with Persistent Left Superior Vena Cava: Distinction between AV Nodal Versus Atrial Reentry. J Arrhythm 2010. [DOI: 10.1016/s1880-4276(10)80018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
We report a rare case of atrial tachycardia originating from the non-coronary aortic sinus. After failed radiofrequency (RF) energy applications at right His-bundle region, the complete elimination of atrial tachycardia was achieved with an RF energy application in the non-coronary aortic sinus. With the review of other papers, this report emphasizes the importance of mapping in the non-coronary aortic sinus in focal atrial tachycardia near the atrioventricular node or near the His-bundle.
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Affiliation(s)
- Boyoung Joung
- Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soon Kim
- Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea
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26
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Zhao Z, Li X, Guo J. Electrophysiologic characteristics of atrial tachycardia originating from the superior vena cava. J Interv Card Electrophysiol 2008; 24:89-94. [DOI: 10.1007/s10840-008-9324-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/15/2008] [Indexed: 11/29/2022]
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DAS SAUMYA, NEUZIL PETR, ALBERT CHRISTINEM, D'AVILA ANDRE, MANSOUR MOUSSA, MELA THEOFANIE, ELLINOR PATRICKT, SINGH JAGMEET, PATTON KRISTEN, RUSKIN JEREMYN, REDDY VIVEKY. Catheter Ablation of Peri-AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic Valve. J Cardiovasc Electrophysiol 2008; 19:231-7. [DOI: 10.1111/j.1540-8167.2007.01024.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hasdemir C, Yavuzgil O, Payzin S, Aydin M, Ulucan C, Kayikcioglu M, Can LH, Turkoglu C, Kultursay H. Angiographic analysis of the anatomic relation of coronary arteries to mitral and tricuspid annulus and implications for radiofrequency ablation. Am J Cardiol 2007; 100:666-71. [PMID: 17697826 DOI: 10.1016/j.amjcard.2007.03.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 03/13/2007] [Accepted: 03/13/2007] [Indexed: 11/24/2022]
Abstract
Coronary artery (CA) narrowings and/or occlusions after radiofrequency ablation (RFA) have been reported. The aim of this study was to describe the in vivo topographic anatomy of CAs and their anatomic relation to the mitral and tricuspid annulus using selective coronary angiography. Fifty consecutive patients undergoing RFA for narrow QRS complex tachycardia were included in the study. Multipolar electrode catheters were inserted into the right atrial appendage, His bundle region, distal coronary sinus (CS), and right ventricle. A mapping catheter was placed across the subeustachian isthmus (SEI). Selective coronary angiography was performed. The maximum and minimum distances between the distal CAs and the mapping catheter located along the mitral and tricuspid annulus were measured during systole and diastole and in right and left anterior oblique projections. The large (> or =1.5 mm) distal right CA was < or =5 mm from the mapping catheter in the SEI in 4 patients (8%). The large posterolateral branch of the right CA was < or =2 mm from the CS Os-middle cardiac vein in 10 patients (20%). The large left circumflex CA was < or =2 mm from the floor or ceiling of the CS in 7 patients (14%) and < or =2 mm from the CS catheter at the lateral and anterolateral mitral annulus in 12 patients (24%). RFA was canceled in 2 patients because of the close proximity (< or =2 mm) of the distal CA to the ablation site. In conclusion, large CAs are frequently located in close proximity to the common ablation sites. Coronary angiography should be considered in children and adults who may develop any signs or symptoms suggestive of acute CA occlusion until larger controlled series are available.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
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30
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Rostock T, Lutomsky B, Steven D, Willems S. The Coronary Sinus as a Focal Source of Paroxysmal Atrial Fibrillation: More Evidence for the ?Fifth Pulmonary Vein?? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1027-31. [PMID: 17669090 DOI: 10.1111/j.1540-8159.2007.00805.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The coronary sinus (CS) has been described as a substrate being involved in the atrial fibrillation (AF) process. However, there are no data describing the CS as a single source of AF. We report a patient with paroxysmal AF who demonstrated an arrhythmogenic focus within the proximal CS as single source initiating and driving AF. This discrete spot was characterized by a sharp "pulmonary vein-like" spike potential preceding every beat during AF and following the atrial potential during sinus rhythm. Radiofrequency ablation at that site led to elimination of the spike potential, disappearance and noninducibility of AF.
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Affiliation(s)
- Thomas Rostock
- Department of Cardiology, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
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31
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Haïssaguerre M, Hocini M, Takahashi Y, O'Neill MD, Pernat A, Sanders P, Jonsson A, Rotter M, Sacher F, Rostock T, Matsuo S, Arantés L, Teng Lim K, Knecht S, Bordachar P, Laborderie J, Jaïs P, Klein G, Clémenty J. Impact of Catheter Ablation of the Coronary Sinus on Paroxysmal or Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2007; 18:378-86. [PMID: 17394452 DOI: 10.1111/j.1540-8167.2007.00764.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluated the impact of catheter ablation of the coronary sinus (CS) region during paroxysmal and persistent atrial fibrillation (AF). BACKGROUND The CS musculature and connections have been implicated in the genesis of atrial arrhythmias. METHODS Forty-five patients undergoing catheter ablation of AF were studied. The CS was targeted if AF persisted after ablation of pulmonary veins and selected left atrial tissue. CS ablation was commenced endocardially by dragging along the inferior paramitral left atrium. Ablation was continued from within the vessel (epicardial) if CS electrograms had cycle lengths shorter than that of the left atrial appendage. RF energy was limited to 35 W endocardially and 25 W epicardially. The impact of ablation was evaluated on CS electrogram cycle length (CSCL) and activation sequence, atrial fibrillatory cycle length measured in the left atrial appendage (AFCL) and on perpetuation of AF. RESULTS Endocardial ablation significantly prolonged CSCL by 17 +/- 5 msec and organized the CS activation sequence (from 13% of patients before to 51% after ablation); subsequent epicardial ablation further increased local CSCL by 32 +/- 27 msec (P < 0.001). AFCL prolonged significantly both during endocardial and epicardial ablation (median: 152 to 167 msec P = 0.03) and was associated with AF termination in 16 (35%) patients (46% of paroxysmal and 30% of persistent AF). AFCL prolongation > or =5 msec and/or AF termination was associated with more rapid activity in the CS region originally: P < or = 0.04. CONCLUSION Catheter ablation targeting both the endocardial and epicardial aspects of the CS region significantly prolongs fibrillatory cycle length and terminates AF persisting after PV isolation in 35% of patients.
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Zhou Y, Guo J, Xu Y, Li X, Zhang P, Zhang H. Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from para-Hisian region. Int J Clin Pract 2007; 61:385-91. [PMID: 17313604 DOI: 10.1111/j.1742-1241.2006.01203.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study describes the electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia (AT) arising from para-Hisian region in 14 (6.0%) patients of a consecutive series of 224 patients patients. Inverted or biphasic P wave in V(1) and uncharacteristic P wave in inferior leads were observed during tachycardia, suggesting that there isn't a characteristic P-wave morphology for para-Hisian AT. During electrophysiological study, tachycardia could be induced with programmed atrial extrastimuli in 11 patients while a spontaneous onset and offset with "warm-up and cool-down" phenomenon were seen in other three patients. Moreover, the tachycardias were sensitive to intravenous administration of adenosine triphosphate in all patients. On the basis of these findings, the mechanism is suggestive of triggered activity or micro-reentry, but automaticity cannot be conclusively excluded. Radiofrequency energy was delivered to the earliest site of atrial activation during AT. Ablating energy was carefully titrated, starting at 5 W and increasing gradually upto a maximum of 40 W, to achieve the ceasing of tachycardia. The long-term outcome was a 100% success rate in these 14 patients and there were no irreversible complications associated with ablation. Thus, the mapping and ablation of focal AT arising from para-Hisian region is safe and effective, delivery of radiofrequency energy in a titrated manner and continuous monitoring of atrioventricular (AV) conduction advocated to minimise the risk of damage to the anterograde AV conduction.
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Affiliation(s)
- Y Zhou
- Department of Cardiac Electrophysiology, People's Hospital, Peking University, Beijing, China
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Abstract
The thoracic veins are important foci for the genesis of ectopic atrial tachycardia and play a critical role in the pathophysiology of paroxysmal and permanent atrial fibrillation. The pulmonary veins have the highest arrhythmogenic activity and other venous structures (eg, superior vena cava, coronary sinus and ligament of Marshall) have also been shown arrhythmogenic potential. Thoracic veins contain cardiomyocytes with distinct electrical activities and complex anatomical structures. This review summaries the current understanding of the basic and clinical electrophysiology of thoracic vein arrhythmias.
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Affiliation(s)
- Yi-Jen Chen
- Division of Cardiovascular Medicine, Taipei Medical University-Wan-Fang Hospital and School of Medicine, Taipei Medical University, Taipei, Taiwan
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35
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Yamada T, Murakami Y, Plumb VJ, Kay GN. Focal atrial fibrillation originating from the coronary sinus musculature. Heart Rhythm 2006; 3:1088-91. [PMID: 16945808 DOI: 10.1016/j.hrthm.2006.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 05/06/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 35294-0001, USA.
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Surgical Treatment of Chronic Atrial Fibrillation—Unipolar Radiofrequency Ablation versus Cryoablation, and Left Atrial versus Bi-atrial Maze Procedures. J Arrhythm 2006. [DOI: 10.1016/s1880-4276(06)80024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yoshikawa M, Usui A, Ueda Y. Surgical Treatment of Chronic Atrial Fibrillation-Unipolar Radiofrequency Ablation versus Cryoablation, and Left Atrial versus Bi-atrial Maze Procedures-. J Arrhythm 2006. [DOI: 10.4020/jhrs.22.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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