Atrial coronary arteries in areas involved in atrial fibrillation catheter ablation.
BACKGROUND
The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques.


RESULTS
We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection. The sinus node artery (SNA) arose from the circumflex artery in 42% of case; proximal to the LA appendage in 29%, crossing the left atrium (LA) anterior wall; and after the LA appendage in the remaining 13%, crossing the mitral isthmus and passing close to the left pulmonary veins (PVs), the LA roof, and the right superior PV. In 58%, the SNA arose from the right coronary artery. Major arteries (≥ 1 mm in external diameter) were found in the mitral isthmus in 54%, at the LA roof in 54%, and at the LA anterior wall in 29%. Around the left PV ostia, there were areas with major arteries in up to 37% (at the roof and inferior segments) and around the right PV ostia in up to 29% (at the roof segment).


CONCLUSIONS
Major atrial coronary arteries, including the SNA, were commonly found in the areas involved in AF ablation and could cause difficulties in obtaining transmural lesions and electric isolation or even lead to ischemic sinus node or atrial dysfunction.
Pardo Meo
Januário
J
Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Scanavacca
Maurício
M
Sosa
Eduardo
E
Correia
Aristides
A
Hachul
Denise
D
Darrieux
Francisco
F
Lara
Sissy
S
Hardy
Carina
C
Jatene
Fabio
F
Jatene
Marcelo
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery; D002102:Cadaver; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000294:innervation / Q000473:pathology* / Q000601:surgery; D005260:Female; D006325:Heart Atria / Q000294:innervation* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012849:Sinoatrial Node / Q000473:pathology* / Q000601:surgery; D055815:Young Adult