What is the clinical evidence from this study?

Study design: Observational. Population: symptomatic drug refractory atrial fibrillation (n=144). Intervention: Ablation of the coronary sinus and inferior left atrium. Primary outcome: Continued arrhythmic activity within the disconnected coronary sinus after restoration of sinus rhythm.

What question did this study set out to answer?

To investigate the electrophysiologic mechanisms and clinical significance of coronary sinus arrhythmogenicity in driving and maintaining human atrial fibrillation.

August 17, 2007Journal of Cardiovascular Electrophysiology

Focal Arrhythmia Confined Within the Coronary Sinus and Maintaining Atrial Fibrillation

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Key result

Ablation of the coronary sinus and inferior left atrium in 144 patients with refractory AF revealed continued focal arrhythmic activity within the disconnected coronary sinus in 4 patients (3%).

Population

144 patients with symptomatic drug refractory atrial fibrillation, with a specific analysis of 4 male…

Design

Case_series

Authors

SKSébastien KnechtElectrophysiology MOMark O’NeillElectrophysiology SMSeiichiro MatsuoElectrophysiology

Discussion

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Implication

Persistent focal activity after coronary sinus ablation in refractory AF is uncommon; hypothesis-generating and requires prospective validation before targeting.

Key Points

To investigate the electrophysiologic mechanisms and clinical significance of coronary sinus arrhythmogenicity in driving and maintaining human atrial fibrillation.
Evaluated 144 patients with symptomatic, drug-refractory atrial fibrillation who underwent sequential catheter ablation targeting the coronary sinus and inferior left atrium.
Identified patients in whom ablation electrically isolated the coronary sinus and restored sinus rhythm while arrhythmic activity persisted exclusively within the coronary sinus.
Classified confined coronary sinus arrhythmias as focal mechanisms (automaticity or triggered activity) when local electrograms spanned less than 75% of the coronary sinus cycle length.
Arrhythmia confined to the disconnected coronary sinus persisted in 4 male patients (3% of the total cohort; 3 with persistent and 1 with permanent atrial fibrillation) after sinus rhythm restoration.
Repetitive activity isolated within the coronary sinus varied in episode duration from 1 second to 15 minutes, with cycle lengths ranging from 158 to 380 ms.
Electrogram mapping demonstrated a focal mechanism in all 4 patients, with activation patterns consistent with automaticity in 2 patients and triggered activity in 1 patient.

Study Design

Type

Observational (n=144)

Structured PICO

Population

144 patients with symptomatic drug refractory atrial fibrillation, with a specific analysis of 4 male patients (3 persistent, 1 permanent AF) who had continued arrhythmic activity in the coronary sinus after electrical dissociation.

Intervention

Ablation of the coronary sinus and inferior left atrium.

Outcome

Electrophysiologic mechanism of confined arrhythmia in the coronary sinus.surrogate

The coronary sinus may act as a source of focal rapid activity that maintains atrial fibrillation, highlighting its potential role as an ablation target.

Cite This Study

Knecht et al. (2007) conducted an observational in symptomatic drug refractory atrial fibrillation (n=144). Ablation of the coronary sinus and inferior left atrium was evaluated on Continued arrhythmic activity within the disconnected coronary sinus after restoration of sinus rhythm. Ablation of the coronary sinus and inferior left atrium in 144 patients with refractory AF revealed continued focal arrhythmic activity within the disconnected coronary sinus in 4 patients (3%).

synapsesocial.com/papers/6a154c7b79ff98d0de4e6716 https://doi.org/10.1111/j.1540-8167.2007.00927.x

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Implication

Persistent focal activity after coronary sinus ablation in refractory AF is uncommon; hypothesis-generating and requires prospective validation before targeting.

Focal Arrhythmia Confined Within the Coronary Sinus and Maintaining Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Focal Arrhythmia Confined Within the Coronary Sinus and Maintaining Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

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