Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Arrhythmia/Electrophysiology
Coronary Sinus Activation Pattern in the Differential Diagnosis of Regular Atrial Tachyarrhythmias During Catheter Ablation of Atrial Fibrillation
Ki-Hun KimGi-Byoung NamEun-Sun JinDong-Kie KimSang-Hoon SeolDoo-Il KimHyungOh ChoiYoo Ri KimSung-Hwan KimKee-Joon ChoiYou-Ho Kim
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2013 Volume 77 Issue 3 Pages 619-625

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Abstract

Background: Prompt diagnosis and management of atrial tachyarrhythmias (ATAs) during catheter ablation of atrial fibrillation (AF) is still challenging. Methods and Results: In 88 patients undergoing catheter ablation of AF, 128 regular ATAs were induced or converted from AF. The coronary sinus activation time (CSAT) around the mitral annulus (MA) was measured as the difference in activation time between the most proximal and distal poles of the coronary sinus (CS) electrodes. Entrainment pacing was performed around the MA, roof area, or cavotricuspid isthmus (CTI) depending on the CSAT result. Mechanisms of tachycardias included macro-reentry around the MA (perimitral atrial flutter [PM-AFL], n=63), roof-dependent AFL (Roof-AFL, n=14), CTI-dependent AFL (CTI-AFL, n=25), and atrial tachycardia (AT, n=26). When the CSAT was ≥45ms, the MA activation sequence was sequential, either proximal to distal or distal to proximal. When the CSAT was <45ms, the MA activation sequence was mainly non-sequential with converging or diverging patterns. CSAT <45ms was highly sensitive in ruling out PM-AFL from other left ATAs. When combined with PPI data from the MA, roof area or CTI, PM-, Roof-, CTI-AFL and AT was successfully differentiated with a high predictive accuracy. Conclusions: A diagnostic algorithm combining CSAT and entrainment pacing is helpful to assess the mechanism of ATAs during catheter ablation of AF.  (Circ J 2013; 77: 619–625)

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© 2013 THE JAPANESE CIRCULATION SOCIETY
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