title: Anatomical relationship of coronary sinus/great cardiac vein and left circumflex coronary artery along mitral annulus in atrial fibrillation before radiofrequency catheter ablation using 320-slice CT.
abstract: OBJECTIVE
  We evaluated anatomical relationships between the coronary sinus and great cardiac vein (CS/GCV) and left circumflex coronary artery (LCX) along the mitral annulus (MA) in patients with atrial fibrillation (AF) using 320-slice CT.
  
  
  METHODS
  Fifty-three patients with AF (44 males; mean 63 ± 11 years; 28 paroxysmal, 10 persistent, and 15 permanent AF) underwent 320-slice CT. Double-oblique CT images perpendicular to the MA short axis were created every 10° for 36 circumferential sections. The angle of 0° corresponded to the 12 o'clock position.
  
  
  RESULTS
  CS/GCV-MA distance was greatest in the posterolateral MA. CS/GCV diverged from the LCX more widely in the lateral through posterolateral MA than the anterior through anterolateral MA. CS/GCV crossed the LCX in 51 patients (96.2%) and left main coronary artery in 2 patients (3.8%). Median angle of the CS/GCV-LCX crossing point was at 40° but ranged widely (0° to 150°) and was more frequent in the anterior and anterolateral MA than in the lateral, posterolateral, and posterior MA (31.4%, 45.1%, 11.8%, 11.8%, and 0%, respectively; P<0.01). CS/GCV crossed over the LCX in 39 patients and under the LCX in 12 patients. Range of the CS/GCV-LCX overlapping course increased significantly as the CS/GCV-LCX crossing point neared the CS ostium. Correlation coefficient between the range of the overlapping course and crossing point angle was 0.78.
  
  
  CONCLUSIONS
  Anatomical relationships between CS/GCV and LCX greatly varied in location and proximity among AF patients. Interventional electrophysiologists should know the potential risk for LCX injury when radiofrequency energy is delivered within the CS/GCV.
authors: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan.
authors: Kohki
authors: K
authors: Nakamura
authors: Nobusada
authors: N
authors: Funabashi
authors: Shigeto
authors: S
authors: Naito
authors: Masae
authors: M
authors: Uehara
authors: Hiroyuki
authors: H
authors: Takaoka
authors: Kenichi
authors: K
authors: Kaseno
authors: Koji
authors: K
authors: Kumagai
authors: Shigeru
authors: S
authors: Oshima
authors: Yoshio
authors: Y
authors: Kobayashi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D054326:Coronary Sinus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery
keywords: 320-slice CT; Atrial fibrillation; Coronary sinus/great cardiac vein; Left circumflex coronary artery; Radiofrequency catheter ablation