title: Standard right atrial ablation is effective for atrioventricular nodal reentry with earliest activation in the coronary sinus.
abstract: BACKGROUND
  Reports suggest that coronary sinus (CS) or left atrial ablations may be necessary for treatment of AV nodal reentrant tachycardia (AVNRT) with earliest retrograde atrial activation in the CS. We assessed the efficacy of standard right atrial catheter ablation approaches in these tachycardias and determined the incidence of earliest activation in the CS in AVNRT.
  
  
  RESULTS
  We retrospectively evaluated intracardiac recordings from 225 consecutive patients who underwent electrophysiologic studies and radiofrequency (RF) ablation for AVNRT in two institutions. Atrial activation during AVNRT was evaluated using multiple catheters according to standard protocol used in our laboratories. RF ablations in the triangle of Koch were performed in all patients. Eighteen of 225 patients (8%) had earliest activation in one of the CS poles. The demographics and AVNRT characteristics of these 18 patients were similar to those of the other 207 patients who did not have CS as earliest activation site and included both typical and atypical AVNRT. Following RF ablation, none of the 18 patients had inducible AVNRT.
  
  
  CONCLUSIONS
  Successful RF ablation can be performed at standard sites in the triangle of Koch regardless of earliest site of atrial activation. The incidence of CS as earliest retrograde atrial activation site in AVNRT is 8%.
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA. janechen@im.wustl.edu
authors.forename: Jane
authors.initials: J
authors.lastname: Chen
authors.forename: Frédéric
authors.initials: F
authors.lastname: Anselme
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Smith
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.forename: Panos
authors.initials: P
authors.lastname: Papageorgiou
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
mesh_terms: D000328:Adult; D000368:Aged; D001146:Arrhythmia, Sinus / Q000175:diagnosis / Q000453:epidemiology*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology