title: Catheter ablation of accessory pathways near the coronary sinus: value of defining coronary arterial anatomy.
abstract: BACKGROUND
  Accessory pathways can lie near or within the coronary sinus (CS). Radiofrequency catheter ablation of accessory pathways is a well-established treatment option, but this procedure can cause damage to adjacent coronary arteries.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the anatomic relationship between the coronary arteries and the CS.
  
  
  METHODS
  Retrospective data of patients who underwent catheter ablation of supraventricular tachycardia between June 2011 and August 2013 was reviewed. In addition, detailed analysis of coronary computed tomographic angiography (CTA) data from 50 patients was performed.
  
  
  RESULTS
  Between June 2011 and August 2013, 427 patients underwent catheter ablation of supraventricular tachycardia, of whom 105 (age 28 ± 17 years, 60% male) had accessory pathway-mediated tachycardia. Of these, 23 patients had accessory pathways near the CS, and 60% (N = 14) underwent concurrent coronary angiography. In 4 patients, the posterolateral (inferolateral) branch (PLA) of the right coronary artery was in close proximity to the CS, and 2 patients (18%) had stenosis of the PLA at the site of ablation. On CTA at their closest proximity, the PLA was 1.9 ± 1.3 mm and the left circumflex artery (LCx) was 2.0 ± 0.8 mm from the body of the CS, in right and left coronary artery-dominant patients, respectively. CS ostium and PLA were 3.6 ± 1.9 mm apart. In left-dominant patients, LCx and CS ostium were 3.8 ± 1.2 mm apart.
  
  
  CONCLUSIONS
  The PLA and LCx are in close proximity to the anteroinferior aspect of the CS ostium and proximal CS. The relationship of the CS and coronary arteries should be evaluated before ablation at these sites.
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mao
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
authors.forename: John M
authors.initials: JM
authors.lastname: Moriarty
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Loma Linda University Health Institute, Loma Linda, California.
authors.forename: Ravi
authors.initials: R
authors.lastname: Mandapati
authors.affiliation: Loma Linda University Health Institute, Loma Linda, California.
authors.forename: Noel G
authors.initials: NG
authors.lastname: Boyle
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. Electronic address: mvaseghi@mednet.ucla.edu.
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000000981:diagnostic imaging / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D017023:Coronary Angiography / Q000379:methods; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Catheter ablation; Coronary artery injury; Coronary artery stenosis; Coronary sinus