Pattern and Timing of the Coronary Sinus Activation to Guide Rapid Diagnosis of Atrial Tachycardia After Atrial Fibrillation Ablation
Why the study?
Does the pattern and timing of coronary sinus activation accurately diagnose the mechanism and origin of atrial tachycardia after atrial fibrillation ablation?
Population
140 consecutive postpersistent atrial fibrillation ablation patients with sustained atrial tachycardia
Comparison
Analysis of patterns and timing of coronary… vs Conventional mapping
Design
Cohort
Authors
Discussion
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Member takes
Implication
May aid rapid AT mechanism identification post-AF ablation; leaves open prospective validation before changing mapping practice.
Key Points
- Determine whether the activation patterns and timing of the coronary sinus can guide rapid electrophysiological diagnosis of atrial tachycardia following atrial fibrillation ablation.
- Evaluated 140 consecutive patients presenting with sustained atrial tachycardia after persistent atrial fibrillation ablation using conventional mapping.
- Characterized coronary sinus activation patterns and measured mid-coronary sinus timing relative to the P-peak-to-P-peak interval in lead V1 across 223 diagnosed tachycardias.
- Out of 223 tachycardias (124 macroreentrant, 99 centrifugal), chevron or reverse chevron coronary sinus activation occurred in 20% (n=44) and largely indicated roof-dependent macroreentry.
- Proximal-to-distal activation with mid-coronary sinus activation at 50% to 70% of the P-P interval identified peritricuspid tachycardia with 81% sensitivity and 89% specificity (n=30).
- Distal-to-proximal activation with mid-coronary sinus activation at 10% to 40% of the P-P interval identified perimitral tachycardia with 88% sensitivity and 75% specificity (n=44).
Structured PICO
Does the pattern and timing of coronary sinus activation accurately diagnose the mechanism and origin of atrial tachycardia after atrial fibrillation ablation?
P
Population
140 consecutive postpersistent atrial fibrillation ablation patients with sustained atrial tachycardia (223 diagnosed ATs)
I
Intervention
Analysis of patterns and timing of coronary sinus (CS) activation (including chevron/reverse chevron patterns and mid-CS activation time to AT cycle length ratio)
C
Comparator
Conventional mapping
O
Outcome
Diagnostic accuracy (sensitivity and specificity) for identifying the mechanism and origin of atrial tachycardias (e.g., peritricuspid, perimitral)surrogate
Analysis of coronary sinus activation patterns and timing provides a rapid and accurate method to stratify macroreentrant atrial tachycardias and identify the likely origin of centrifugal atrial tachycardias following atrial fibrillation ablation.
Cite This Study
Pascale et al. (2013) studied this question.