Key result
During cavotricuspid isthmus ablation, the intracardiac activation sequence in the coronary sinus changed without altering cycle length or P-wave morphology, suggesting blocked interatrial connection.
Case Report (n=1)
Highlights an electrophysiological phenomenon where coronary sinus activation sequence changes during cavotricuspid isthmus ablation, indicating block of interatrial connection via the coronary sinus.
Requires caution interpreting CS activation during CTI ablation; hypothesis-generating observation extending knowledge of interatrial connections.
A 69-year-old woman was referred for cavotricuspid isthmus ablation due to typical isthmus-dependent right atrial flutter. During ablation, intracardiac activation sequence in coronary sinus (CS) changed without altering the cycle length or the P-wave morphology. This suggests that interatrial connection via CS was blocked and left atrium (LA) was activated from Bachmann's bundle or/and connections between fossa ovalis and LA.
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Buchta et al. (2012) conducted a case report in Typical isthmus-dependent right atrial flutter (n=1). Cavotricuspid isthmus ablation was evaluated. During cavotricuspid isthmus ablation, the intracardiac activation sequence in the coronary sinus changed without altering cycle length or P-wave morphology, suggesting blocked interatrial connection.
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