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Isolation of Canine Coronary Sinus Musculature from the Atria by Radiofrequency Catheter Ablation Prevents Induction of Atrial Fibrillation.
MedLine Citation:
PMID:  25381330     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -The junction between the coronary sinus (CS) musculature and both atria contributes to initiation of atrial tachyarrhythmias. The current study investigated the effects of CS isolation from the atria by radiofrequency catheter ablation (RFCA) on the induction and maintenance of AF.
METHODS AND RESULTS: -Using an optical mapping system, we mapped action potentials at 256 surface sites in 17 isolated and arterially-perfused canine atrial tissues containing the entire musculature of the CS, right atrial septum (RA), posterior left atrium (LA), left inferior pulmonary vein (PV) and vein of Marshal (VOM). Rapid pacing from each site before and after addition of acetylcholine (ACh: 0.5 μM) was applied to induce AF. Epicardial RFCA at CS-atrial junctions isolated the CS from the atria. Rapid pacing induced sustained AF in all tissues after ACh. Microreentry within the CS drove AF in 88% of preparations. Reentries associated with the VOM (29%), CS-atrial junctions (53%), RA (65%), and PV (76%) (frequently with 2-4 simultaneous circuits) were additional drivers of AF. RFCA eliminated AF in 13 tissues before ACh (p<0.01) and in 5 tissues after ACh. RFCA also abbreviated the duration of AF in 12 tissues (p<0.01).
CONCLUSIONS: -CS and its musculature developed unstable reentry and AF, which were prevented by isolation of CS musculature from atrial tissue. The results suggest that CS can be a substrate of recurrent AF in patients after PV isolation and that CS isolation might help prevent recurrent AF.
Authors:
Hiroshi Morita; Douglas P Zipes; Shiho T Morita; Jiashin Wu
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-7
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-8     Completed Date:  -     Revised Date:  2014-11-9    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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