title: Impact of catheter ablation of the coronary sinus on paroxysmal or persistent atrial fibrillation.
abstract: 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.
authors: Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
authors: Michel
authors: M
authors: Haïssaguerre
authors: Mélèze
authors: M
authors: Hocini
authors: Yoshihide
authors: Y
authors: Takahashi
authors: Mark D
authors: MD
authors: O'Neill
authors: Andrej
authors: A
authors: Pernat
authors: Prashanthan
authors: P
authors: Sanders
authors: Anders
authors: A
authors: Jonsson
authors: Martin
authors: M
authors: Rotter
authors: Frederic
authors: F
authors: Sacher
authors: Thomas
authors: T
authors: Rostock
authors: Seiichiro
authors: S
authors: Matsuo
authors: Leonardo
authors: L
authors: Arantés
authors: Kang
authors: K
authors: Teng Lim
authors: Sébastien
authors: S
authors: Knecht
authors: Pierre
authors: P
authors: Bordachar
authors: Julien
authors: J
authors: Laborderie
authors: Pierre
authors: P
authors: Jaïs
authors: George
authors: G
authors: Klein
authors: Jacques
authors: J
authors: Clémenty
mesh_terms: 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