title: Pattern and timing of the coronary sinus activation to guide rapid diagnosis of atrial tachycardia after atrial fibrillation ablation.
abstract: BACKGROUND
  Atrial tachycardias (AT) during or after ablation of atrial fibrillation frequently pose a diagnostic challenge. We hypothesized that both the patterns and the timing of coronary sinus (CS) activation could facilitate AT mapping.
  
  
  RESULTS
  A total of 140 consecutive postpersistent atrial fibrillation ablation patients with sustained AT were investigated by conventional mapping. CS activation pattern was defined as chevron or reverse chevron when the activations recorded on both the proximal and the distal CS dipoles were latest or earliest, respectively. The local activation of mid-CS was timed with reference to Ppeak-Ppeak (P-P) interval in lead V1. A ratio, mid-CS activation time to AT cycle length, was computed. Of 223 diagnosed ATs, 124 were macroreentrant (56%) and 99 were centrifugal (44%). When CS activation was chevron/reverse chevron (n=44; 20%), macroreentries were mostly roof dependent. With reference to P-P interval, mid-CS activation timing showed specific consistency for peritricuspid and perimitral AT. Proximal to distal CS activation pattern and mid-CS activation at 50% to 70% of the P-P interval (n=30; 13%) diagnosed peritricuspid AT with 81% sensitivity and 89% specificity. Distal to proximal CS activation and mid-CS activation at 10% to 40% of the P-P interval (n=44; 20%) diagnosed perimitral AT with 88% sensitivity and 75% specificity.
  
  
  CONCLUSIONS
  The analysis of the patterns and timing of CS activation provides a rapid stratification of most likely macroreentrant ATs and points toward the likely origin of centrifugal ATs. It can be included in a stepwise diagnostic approach to rapidly select the most critical mapping maneuvers.
authors: Hôpital Cardiologique du Haut-Lévêque & Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France. Patrizio.Pascale@chuv.ch
authors: Patrizio
authors: P
authors: Pascale
authors: Ashok J
authors: AJ
authors: Shah
authors: Laurent
authors: L
authors: Roten
authors: Daniel
authors: D
authors: Scherr
authors: Yuki
authors: Y
authors: Komatsu
authors: Amir S
authors: AS
authors: Jadidi
authors: Khaled
authors: K
authors: Ramoul
authors: Matthew
authors: M
authors: Daly
authors: Arnaud
authors: A
authors: Denis
authors: Stephen B
authors: SB
authors: Wilton
authors: Nicolas
authors: N
authors: Derval
authors: Frédéric
authors: F
authors: Sacher
authors: Mélèze
authors: M
authors: Hocini
authors: Michel
authors: M
authors: Haïssaguerre
authors: Pierre
authors: P
authors: Jaïs
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D054326:Coronary Sinus; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; atrial flutter; atrial tachycardia; coronary sinus; electrophysiology mapping; mapping