Document Detail


Left atrial coronary perfusion territories in isolated sheep hearts: implications for atrial fibrillation maintenance.
MedLine Citation:
PMID:  20621203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The role of coronary perfusion in the maintenance of atrial fibrillation (AF) electrical sources that anchor to the posterior (wall of the) left atrium (PLA) has been incompletely investigated. We hypothesized that the PLA-pulmonary vein region is perfused by branches originating from both the right and left coronary arteries.
OBJECTIVE: The purpose of this study was to evaluate whether branches originating from the right and left coronary arteries could serve as conduits to chemically ablate restricted PLA regions.
METHODS: In Langendorff-perfused sheep hearts, the right anterior and left anterior atrial arteries (RAAA and LAAA) and the branches of the left circumflex artery (LCX) were identified as main coronary artery branches perfusing the atria. During sustained AF, 20-mL boluses of cold Tyrode's solution (4°C) was injected into each artery to determine changes in dominant frequency. The injection that yielded the largest dominant frequency decrease indicated the coronary branch to be subsequently perfused with ethanol. Ethanol was selectively injected into the LAAA (n = 4), LCX (n = 4), or RAAA (n = 1).
RESULTS: Six of nine AF cases rapidly terminated upon ethanol perfusion. In those hearts and in eight additional preparations (n = 17), Congo red and Evans blue was subsequently perfused into the remaining atrial branches. The perfusion territories were classified as triple-vessel PLA perfusion (n = 4), LAAA-dominant PLA perfusion (n = 5), balanced double-vessel PLA perfusion (n = 5), and LCX or RAAA dominant (n = 3).
CONCLUSION: PLA coronary perfusion relies on a variable contribution of right and left coronary branches. Regional irrigation of ethanol in well-delineated PLA perfusion territories enabled ablation of high-frequency sites during AF.
Authors:
Masatoshi Yamazaki; Sherry Morgenstern; Matthew Klos; Katherine Campbell; Daniel Buerkel; Jérôme Kalifa
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-07-08
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2011-02-04     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1501-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Ablation Techniques
Animals
Atrial Fibrillation / physiopathology*,  surgery
Cardiac Pacing, Artificial
Catheter Ablation
Coronary Circulation*
Coronary Vessels / physiopathology
Ethanol / pharmacology
Heart Atria / physiopathology
Isotonic Solutions / pharmacology
Pulmonary Veins / physiopathology
Sheep, Domestic
Grant Support
ID/Acronym/Agency:
P01 HL039707/HL/NHLBI NIH HHS; P01 HL087226/HL/NHLBI NIH HHS; R01 HL070074/HL/NHLBI NIH HHS; R01 HL087055/HL/NHLBI NIH HHS; R01-HL087055/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Isotonic Solutions; 0/Tyrode's solution; 3K9958V90M/Ethanol
Comments/Corrections

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


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