Impact of catheter ablation of the coronary sinus on paroxysmal or persistent atrial fibrillation.
OBJECTIVE
This study evaluated the impact of catheter ablation of the coronary sinus (CS) region during paroxysmal and persistent atrial fibrillation (AF).


BACKGROUND
The CS musculature and connections have been implicated in the genesis of atrial arrhythmias.


METHODS
Forty-five patients undergoing catheter ablation of AF were studied. The CS was targeted if AF persisted after ablation of pulmonary veins and selected left atrial tissue. CS ablation was commenced endocardially by dragging along the inferior paramitral left atrium. Ablation was continued from within the vessel (epicardial) if CS electrograms had cycle lengths shorter than that of the left atrial appendage. RF energy was limited to 35 W endocardially and 25 W epicardially. The impact of ablation was evaluated on CS electrogram cycle length (CSCL) and activation sequence, atrial fibrillatory cycle length measured in the left atrial appendage (AFCL) and on perpetuation of AF.


RESULTS
Endocardial ablation significantly prolonged CSCL by 17 +/- 5 msec and organized the CS activation sequence (from 13% of patients before to 51% after ablation); subsequent epicardial ablation further increased local CSCL by 32 +/- 27 msec (P < 0.001). AFCL prolonged significantly both during endocardial and epicardial ablation (median: 152 to 167 msec P = 0.03) and was associated with AF termination in 16 (35%) patients (46% of paroxysmal and 30% of persistent AF). AFCL prolongation > or =5 msec and/or AF termination was associated with more rapid activity in the CS region originally: P < or = 0.04.


CONCLUSIONS
Catheter ablation targeting both the endocardial and epicardial aspects of the CS region significantly prolongs fibrillatory cycle length and terminates AF persisting after PV isolation in 35% of patients.
Haïssaguerre
Michel
M
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Hocini
Mélèze
M
Takahashi
Yoshihide
Y
O'Neill
Mark D
MD
Pernat
Andrej
A
Sanders
Prashanthan
P
Jonsson
Anders
A
Rotter
Martin
M
Sacher
Frederic
F
Rostock
Thomas
T
Matsuo
Seiichiro
S
Arantés
Leonardo
L
Teng Lim
Kang
K
Knecht
Sébastien
S
Bordachar
Pierre
P
Laborderie
Julien
J
Jaïs
Pierre
P
Klein
George
G
Clémenty
Jacques
J
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004699:Endocardium / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D012849:Sinoatrial Node / Q000601:surgery*; D016896:Treatment Outcome