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CLINICAL RESEARCH: CARDIAC RHYTHM DISORDER

Atrial Tachycardia Arising From the Coronary Sinus Musculature

Electrophysiological Characteristics and Long-Term Outcomes of Radiofrequency Ablation

Nitish Badhwar, MBBS, FACC^_*, Jonathan M. Kalman, MBBS, PhD, FACC, Paul B. Sparks, MBBS, PhD, Peter M. Kistler, MBBS, Mehran Attari, MD, Marcie Berger, MD, FACC, Randall J. Lee, MD, PhD, FACC^_*, Jasbir Sra, MD, FACC and Melvin M. Scheinman, MD, FACC^_*,_*

^_* University of California, San Francisco, San Francisco, California
Royal Melbourne Hospital, Melbourne, Australia
Aurora Sinai/St. Luke’s Medical Centers, University of Wisconsin Medical School-MCC, Milwaukee, Wisconsin

Manuscript received April 19, 2005; revised manuscript received May 26, 2005, accepted July 4, 2005.

^_* Reprint requests and correspondence: Dr. Melvin M. Scheinman, Section of Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, MU-East 434, Box 1354, San Francisco, California 94143. (Email: scheinman{at}medicine.ucsf.edu).

OBJECTIVES: We sought to describe the electrophysiological features and long-term outcome after radiofrequency catheter ablation (RFCA) of atrial tachycardia (AT) arising from the coronary sinus (CS) musculature.

BACKGROUND: Atrial tachycardia requiring RFCA deep within the CS has been described in isolated case reports. However, the mechanism and exact site of origin of this tachycardia have not been well elucidated.

METHODS: The study included 8 patients (5 men) of a consecutive series of 283 patients undergoing RFCA for focal AT.

RESULTS: In sinus rhythm, a discrete potential (P) was noted after the CS atrial electrogram and during tachycardia, the CS (P) preceded the surface P-wave by 30 to 50 ms. The CS (P) always preceded the earliest electrogram in the left atrium (LA). Three-dimensional electroanatomical mapping was available in four patients, and in one case it showed earliest activation in the CS with rapid spread to the proximal CS and then to the LA. Ablation of the AT initially attempted from the earliest site in the LA in three patients was unsuccessful. In all patients the tachycardia was safely and successfully ablated at a site 3.6 cm within the CS. There has been no recurrence over a follow-up of 37 ± 13 months.

CONCLUSIONS: Focal AT emanating deep within the CS musculature can be recognized by a discrete potential associated with the CS atrial signal both during sinus rhythm and tachycardia. Long-term success without complications can be accomplished by ablating within the CS in close proximity to the CS (P).

Abbreviations and Acronyms   AOD = atrial overdrive pacing   AT = atrial tachycardia   CS = coronary sinus   CS (A) = coronary sinus atrial electrogram   CS (P) = coronary sinus potential   LA = left atrium   LOM = ligament of Marshall   RA = right atrium   RFCA = radiofrequency catheter ablation   3D = three-dimensional

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