title: Coronary sinus activation pattern in the differential diagnosis of regular atrial tachyarrhythmias during catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Prompt diagnosis and management of atrial tachyarrhythmias (ATAs) during catheter ablation of atrial fibrillation (AF) is still challenging.
  
  
  RESULTS
  In 88 patients undergoing catheter ablation of AF, 128 regular ATAs were induced or converted from AF. The coronary sinus activation time (CSAT) around the mitral annulus (MA) was measured as the difference in activation time between the most proximal and distal poles of the coronary sinus (CS) electrodes. Entrainment pacing was performed around the MA, roof area, or cavotricuspid isthmus (CTI) depending on the CSAT result. Mechanisms of tachycardias included macro-reentry around the MA (perimitral atrial flutter [PM-AFL], n=63), roof-dependent AFL (Roof-AFL, n=14), CTI-dependent AFL (CTI-AFL, n=25), and atrial tachycardia (AT, n=26). When the CSAT was ≥ 45 ms, the MA activation sequence was sequential, either proximal to distal or distal to proximal. When the CSAT was <45 ms, the MA activation sequence was mainly non-sequential with converging or diverging patterns. CSAT <45 ms was highly sensitive in ruling out PM-AFL from other left ATAs. When combined with PPI data from the MA, roof area or CTI, PM-, Roof-, CTI-AFL and AT was successfully differentiated with a high predictive accuracy.
  
  
  CONCLUSIONS
  A diagnostic algorithm combining CSAT and entrainment pacing is helpful to assess the mechanism of ATAs during catheter ablation of AF.
authors.affiliation: Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.forename: Eun-Sun
authors.initials: ES
authors.lastname: Jin
authors.forename: Dong-Kie
authors.initials: DK
authors.lastname: Kim
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Seol
authors.forename: Doo-Il
authors.initials: DI
authors.lastname: Kim
authors.forename: Hyungoh
authors.initials: H
authors.lastname: Choi
authors.forename: Yoo Ri
authors.initials: YR
authors.lastname: Kim
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D054326:Coronary Sinus / Q000503:physiopathology*; D003937:Diagnosis, Differential; D019468:Disease Management; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D011446:Prospective Studies; D013610:Tachycardia / Q000175:diagnosis* / Q000503:physiopathology*; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000503:physiopathology