June 20, 2020Journal of Cardiovascular Electrophysiology
Electrophysiologic evidence of epicardial connections between low right atrium and remote right atrial region or coronary sinus musculature: Relevance for catheter ablation of typical atrial flutter
Why the study?
Clinically relevant epicardial connections from coronary sinus musculature toward the low right atrium, or between two regions of the right atrium, remain questionable.
Population
Five patients undergoing electrophysiology study for typical atrial flutter
Design
Case series
Authors
Discussion
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Implication
May support adjunctive CS ostium ablation after failed endocardial CTI block; hypothesis-generating for epicardial connections.
Key Points
- The aim is to investigate epicardial connections between the coronary sinus, low right atrium, and remote right atrial regions to improve ablation strategies for typical atrial flutter.
- Five patients underwent electrophysiology study for typical atrial flutter using multipolar catheters or high-density mapping.
- Radiofrequency applications were performed at the cavotricuspid isthmus and cardiac vein/CS ostium.
- A detailed analysis of activation patterns and ablation outcomes was conducted.
- All patients exhibited a similar sequence of events during electrophysiology studies with persistence of tachycardia despite successful endocardial block.
- Sinus rhythm was restored in four patients after RF applications at the cardiac vein/CS ostium.
- High-density mapping revealed an unexpected breakthrough site at the septal side of the ablation line in one patient, leading to successful tachycardia termination.
Structured PICO
P
Population
5 patients undergoing electrophysiology study for typical atrial flutter
I
Intervention
Electrophysiology study and radiofrequency ablation using conventional multipolar catheters (n=4) or three-dimensional high-density mapping system (n=1)
O
Outcome
Restoration of sinus rhythm or tachycardia terminationsurrogate
Epicardial connections can bypass endocardial CTI block during atrial flutter ablation, and recognizing this allows for successful targeted ablation at the CS ostium.
Cite This Study
Chaumont et al. (2020) studied this question.