Document Detail

Focal arrhythmia confined within the coronary sinus and maintaining atrial fibrillation.
MedLine Citation:
PMID:  17711438     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The coronary sinus (CS) is a complex structure comprising a mesh of circumferential muscular fibers with oblique connections to both atria. We describe further evidence for the clinical importance of CS arrhythmogenicity in maintaining atrial fibrillation (AF) in humans. METHODS: Since January 2004, following a sequential approach, the CS and the inferior left atrium were ablated in 144 patients with symptomatic drug refractory AF. Patients were included for analysis when this step resulted in the electrical dissociation of the CS from both atria with restoration of sinus rhythm, but with continued arrhythmic activity in the CS. The electrophysiologic mechanism of the confined arrhythmia was considered as focal activity (automaticity or triggered activity) by the presence of electrograms spanning less than 75% of the cycle length in the CS. RESULTS: After restoration of sinus rhythm, four male patients (3% of the patients, three persistent and one permanent AF) were identified in whom arrhythmia continued within the CS. Repetitive activity confined to the disconnected CS was inconsistent in occurrence, as well as in duration (1 sec to 15 min) and cycle length (from 158 to 380 ms). For all four patients, electrogram mapping of the entire CS was compatible with a focal mechanism. In two patients, bursts alternating with slow dissociated activity suggested automaticity. In one patient, local activity consistently coupled to the previous sinus beat favored triggered activity. CONCLUSIONS: This study provides evidence that the CS may be a potential source of focal rapid activity maintaining AF.
Sébastien Knecht; Mark D O'Neill; Seiichiro Matsuo; Kang-Teng Lim; Leonardo Arantes; Nicolas Derval; Georges J Klein; Mélèze Hocini; Pierre Jaïs; Jacques Clémenty; Michel Haïssaguerre
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-08-16
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  18     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-22     Completed Date:  2007-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1140-6     Citation Subset:  IM    
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. <>
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MeSH Terms
Atrial Fibrillation / physiopathology*,  surgery
Catheter Ablation
Coronary Sinus / physiopathology*
Electrophysiologic Techniques, Cardiac
Middle Aged
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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