title: Role of the coronary sinus in maintenance of atrial fibrillation.
abstract: BACKGROUND
  Bursts of tachycardia arising in the pulmonary veins may play an important role in perpetuating atrial fibrillation (AF). However, the role of the coronary sinus (CS) in the perpetuation of AF has been unclear. The aim of this study was to determine whether the CS plays a role in perpetuation of AF.
  
  
  RESULTS
  Pulmonary vein isolation was performed by segmental ostial ablation with radiofrequency energy in 22 consecutive patients with paroxysmal AF. Bipolar and unipolar electrograms recorded in the left atrium and CS were analyzed during atrial pacing from the mitral annulus and during AF. There was a mean of 2.5 +/- 0.5 electrical connections between the CS and the left atrium. The electrical connections between the left atrium and CS were ablated with a mean of 6.2 +/- 2.7 minutes of radiofrequency energy applied along the atrial side of the inferior mitral annulus. During AF, episodes of intermittent tachycardia alternated between the left atrium and the CS. Among the 22 patients, sustained AF was still inducible in 9 after pulmonary vein isolation. After electrical disconnection of the CS from the left atrium, sustained AF was inducible in only 3 of these 9 patients.
  
  
  CONCLUSIONS
  The CS may be a source of rapid repetitive electrical activity during AF. The lower probability of inducible sustained AF after electrical disconnection of the CS from the left atrium suggests that the CS may play a role in perpetuating AF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA. oralh@umich.edu
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Christoph
authors.initials: C
authors.lastname: Scharf
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Peter
authors.initials: P
authors.lastname: Cheung
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000503:physiopathology*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology; D012008:Recurrence