Focal Atrial Tachycardia From the Ostium of the Coronary Sinus
Electrocardiographic and Electrophysiological Characterization and Radiofrequency Ablation
Peter M. Kistler, MBBS,
Simon P. Fynn, MRCP,
Haris Haqqani, MBBS,
Irene H. Stevenson, MBBS,
Jitendra K. Vohra, MD,
Joseph B. Morton, MBBS, PhD,
Paul B. Sparks, MBBS, PhD and
Jonathan M. Kalman, MBBS, PhD*
Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
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Figure 1 The P-wave morphology from three patients is presented. The characteristic findings were: a deeply inverted P-wave in the inferior leads with 4 of 13 patients having a secondary upright component (B and C). Lead V1 was inverted (B and C) or isoelectric (A) then upright. Leads aVL and aVR were positive in 13 of 13 patients.
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Figure 2 Graphic representation of the mean activation times at each of the recorded endocardial sites for the 13 patients. Earliest endocardial activation on these standard catheters occurred at the proximal coronary sinus (CS) in all 13 patients. CT = crista terminalis; HBE = His bundle. Numbers refer to bipolar pair.
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Figure 3 Endocardial electrograms demonstrating the ablation signal (ABLd) at the successful site 30 ms ahead of P-wave onset. The coronary sinus (CS) is activated from proximal to distal ahead of His activation. AEB = atrial ectopic beat; SR = sinus rhythm.
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Figure 4 Left anterior oblique projections demonstrating a coronary sinus (CS) venogram on the left panel and the successful location for ablation of focal atrial tachycardia at the superior lip of the CS ostium on the right panel. ABL = ablation catheter; RV = right ventricle.
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