Atrial tachycardia arising from the coronary sinus musculature: electrophysiological characteristics and long-term outcomes of radiofrequency ablation.
OBJECTIVE
We sought to describe the electrophysiological features and long-term outcome after radiofrequency catheter ablation (RFCA) of atrial tachycardia (AT) arising from the coronary sinus (CS) musculature.


BACKGROUND
Atrial tachycardia requiring RFCA deep within the CS has been described in isolated case reports. However, the mechanism and exact site of origin of this tachycardia have not been well elucidated.


METHODS
The study included 8 patients (5 men) of a consecutive series of 283 patients undergoing RFCA for focal AT.


RESULTS
In sinus rhythm, a discrete potential (P) was noted after the CS atrial electrogram and during tachycardia, the CS (P) preceded the surface P-wave by 30 to 50 ms. The CS (P) always preceded the earliest electrogram in the left atrium (LA). Three-dimensional electroanatomical mapping was available in four patients, and in one case it showed earliest activation in the CS with rapid spread to the proximal CS and then to the LA. Ablation of the AT initially attempted from the earliest site in the LA in three patients was unsuccessful. In all patients the tachycardia was safely and successfully ablated at a site 3.6 cm within the CS. There has been no recurrence over a follow-up of 37 +/- 13 months.


CONCLUSIONS
Focal AT emanating deep within the CS musculature can be recognized by a discrete potential associated with the CS atrial signal both during sinus rhythm and tachycardia. Long-term success without complications can be accomplished by ablating within the CS in close proximity to the CS (P).
Badhwar
Nitish
N
University of California, San Francisco, San Francisco, California 94143, USA.
Kalman
Jonathan M
JM
Sparks
Paul B
PB
Kistler
Peter M
PM
Attari
Mehran
M
Berger
Marcie
M
Lee
Randall J
RJ
Sra
Jasbir
J
Scheinman
Melvin M
MM
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000503:physiopathology; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000503:physiopathology; D013610:Tachycardia / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors