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Coronary Sinus Tachycardia Driving Atrial Fibrillation

2004; Lippincott Williams & Wilkins; Volume: 110; Issue: 6 Linguagem: Inglês

10.1161/01.cir.0000138256.14084.c2

1524-4539

Martin Rotter, Prashanthan Sanders, Yoshihide Takahashi, Li‐Fern Hsu, Frédéric Sacher, Mélèze Hocini, Pierre Jaı̈s, Michel Haı̈ssaguerre,

Cardiovascular Syncope and Autonomic Disorders

HomeCirculationVol. 110, No. 6Coronary Sinus Tachycardia Driving Atrial Fibrillation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBCoronary Sinus Tachycardia Driving Atrial Fibrillation Martin Rotter, Prashanthan Sanders, Yoshihide Takahashi, Li-Fern Hsu, Frederic Sacher, Mélèze Hocini, Pierre Jaïs and Michel Haïssaguerre Martin RotterMartin Rotter From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Prashanthan SandersPrashanthan Sanders From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Yoshihide TakahashiYoshihide Takahashi From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Li-Fern HsuLi-Fern Hsu From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Frederic SacherFrederic Sacher From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Mélèze HociniMélèze Hocini From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. , Pierre JaïsPierre Jaïs From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. and Michel HaïssaguerreMichel Haïssaguerre From Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France. Originally published10 Aug 2004https://doi.org/10.1161/01.CIR.0000138256.14084.C2Circulation. 2004;110:e59–e60A 59-year-old man underwent radiofrequency catheter ablation for symptomatic drug refractory atrial fibrillation (AF). Prior ablations for AF had included pulmonary vein (PV) electrical isolation and additional substrate modification involving linear ablation joining the 2 superior PVs (roofline) and the anterior mitral annulus with the roofline (anterior line). Despite significant clinical improvement, further mapping and ablation was performed because of recurrent arrhythmia. At the time of the procedure, the ECG demonstrated AF with intermittent termination that was followed by immediate re-initiations, suggestive of a focal source (Figure 1A and 1B). Mapping of the earliest activity during initiation of AF localized the site of origin to the coronary sinus (CS); however, there were changes in local activation sequence suggestive of multiple foci or multiple exits to the left atrium. Radiofrequency energy was delivered at sites of earliest activity within the mid-CS, which was progressively mapped to more proximal sites (Figure 1C). Final application of radiofrequency energy at the ostium of the CS resulted in electrical isolation of the CS from the atria with termination of AF. Despite restoration of sinus rhythm, ongoing fibrillatory activity with a cycle length range from 81 to 210 ms was still recorded in the CS (Figure 2A). This activity occurred in episodic bursts alternating with slow dissociated rhythms without conduction to the adjacent chambers (Figure 2B). After CS isolation, AF could no longer be induced. This unreported observation is conclusive evidence for the role of the CS as an independent driver maintaining AF by sustained or episodic bursts of activities of short cycle length driving the atria. These observations are analogous to the role of the PVs and superior vena cava in AF and further implicate an important function of the thoracic veins in the maintenance of AF. Download figureDownload PowerPointFigure 1. Baseline tracings and fluoroscopy. A, Continuous fibrillatory activity within the CS during AF. Atrial activation in surface ECG appears to be organized, presumably because of prior linear lesions. B, Initiation of AF with earliest activity mapped to the CS. C, Fluoroscopy of catheter positions within the CS; angiography performed after ablation (dimensions 10 to 14 mm from distal to proximal).Download figureDownload PowerPointFigure 2. Persistent tachycardia confined to the CS after electrical isolation. A, Bursts of fibrillatory activity within the CS (cycle length range 81 to 210 ms) while the atria remain in sinus rhythm after isolation of the CS. B, Dissociated slow activity confined to the CS during sinus rhythm.FootnotesCorrespondence to Dr Martin Rotter, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Chaumont C, Saoudi N, Savouré A, Lațcu D and Anselme F (2020) 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, Journal of Cardiovascular Electrophysiology, 10.1111/jce.14627, 31:9, (2344-2351), Online publication date: 1-Sep-2020. Della Rocca D, Tarantino N, Trivedi C, Mohanty S, Anannab A, Salwan A, Gianni C, Bassiouny M, Al‐Ahmad A, Romero J, Briceño D, Burkhardt J, Gallinghouse G, Horton R, Di Biase L and Natale A (2020) Non‐pulmonary vein triggers in nonparoxysmal atrial fibrillation: Implications of pathophysiology for catheter ablation, Journal of Cardiovascular Electrophysiology, 10.1111/jce.14638, 31:8, (2154-2167), Online publication date: 1-Aug-2020. Wu S, Zou G, Liu X, Jiang W, Qin M and Zhang D (2020) Key Role of Left Atrial Appendage during Redo Ablation in a Case of Long-Standing Persistent Atrial Fibrillation, Case Reports in Cardiology, 10.1155/2020/9691584, 2020, (1-4), Online publication date: 19-Jun-2020. 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Lemola K, Mueller G, Desjardins B, Sneider M, Case I, Good E, Han J, Tamirisa K, Tschopp D, Reich S, Igic P, Elmouchi D, Chugh A, Bogun F, Pelosi F, Kazerooni E, Morady F and Oral H (2005) Topographic analysis of the coronary sinus and major cardiac veins by computed tomography, Heart Rhythm, 10.1016/j.hrthm.2005.04.016, 2:7, (694-699), Online publication date: 1-Jul-2005. August 10, 2004Vol 110, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000138256.14084.C2PMID: 15302808 Originally publishedAugust 10, 2004 PDF download Advertisement SubjectsArrhythmiasCatheter Ablation and Implantable Cardioverter-DefibrillatorElectrophysiology