March 19, 2012Journal of Cardiovascular Electrophysiology
Disparate Activation of the Coronary Sinus and Inferior Left Atrium During Atrial Tachycardia After Persistent Atrial Fibrillation Ablation: Prevalence, Pitfalls, and Impact on Mapping
Key result
Disparate left atrial-coronary sinus activations occurred in 13% of atrial tachycardias post-ablation and were associated with a higher rate of perimitral macroreentry (67% vs 29%; P=0.002).
Population
74 consecutive patients with atrial tachycardia occurring after persistent atrial fibrillation ablation
Design
Cohort
Authors
Discussion
Loading...
Member takes
Implication
Disparate LA-CS activations may complicate post-ablation AT mapping; leaves open whether targeted CS assessment refines perimitral reentry diagnosis.
Key Points
- To evaluate the prevalence of disparate coronary sinus and left atrial activation sequences and determine their diagnostic impact on electrophysiological mapping in patients with post-ablation atrial tachycardia.
- Evaluated 74 consecutive patients presenting with atrial tachycardia (AT) after persistent atrial fibrillation (AF) catheter ablation.
- Identified suspected partial coronary sinus (CS) disconnection using double potentials on CS catheters and conducted endocardial mapping opposite CS bipoles to distinguish left atrial (LA) far-field signals from local CS potentials.
- Disparate LA-CS activation patterns were detected in 13% of AT cases (20 of 149), with 90% exhibiting distal-to-proximal LA activation concurrent with proximal-to-distal CS activation.
- Perimitral macroreentry occurred significantly more frequently in tachycardias with disparate LA-CS activation than in those without (67% vs 29%; P = 0.002).
- Partial CS disconnection induced pseudo mitral isthmus block during left atrial appendage pacing in 20% of affected patients.
Study Design
Type
Observational (n=74)
Structured PICO
P
Population
74 consecutive patients with 149 atrial tachycardias occurring after persistent atrial fibrillation ablation.
E
Exposure
Endocardial mapping facing coronary sinus (CS) bipoles to differentiate LA far-field from local CS potentials
O
Outcome
Prevalence of disparate activation sequences of the local CS versus contiguous left atrium (LA) during AT and its impact on activation mappingsurrogate
Main Result
Absolute Event Rate: 67% vs 29%
p-value: p=0.002
Recognizing disparate activation patterns between the coronary sinus and left atrium during atrial tachycardia after AF ablation is crucial to avoid misinterpreting activation maps and mitral isthmus block.
Cite This Study
Pascale et al. (2012) conducted an observational in Atrial tachycardia after persistent atrial fibrillation ablation (n=74). Disparate LA-CS activations vs. No disparate LA-CS activations was evaluated on Perimitral macroreentry (p=0.002). Disparate left atrial-coronary sinus activations occurred in 13% of atrial tachycardias post-ablation and were associated with a higher rate of perimitral macroreentry (67% vs 29%; P=0.002).