Disparate Activation of the Coronary Sinus and Inferior Left Atrium During Atrial Tachycardia After Persistent Atrial Fibrillation Ablation: Prevalence, Pitfalls, and Impact on Mapping

作者：Pascale Patrizio^*; Shah Ashok J; Roten Laurent; Whinnett Zachary; Wilton Stephen B; Jadidi Amir S; Scherr Daniel; Miyazaki Shinsuke; Pedersen Michala; Derval Nicolas; Knecht Sebastien; Sacher Frederic; Hocini Meleze; Haissaguerre Michel; Jais Pierre

来源：Journal of Cardiovascular Electrophysiology, 2012, 23(7): 697-707.

DOI：10.1111/j.1540-8167.2011.02266.x

• atrial fibrillation
• atrial tachycardia
• catheter ablation
• coronary sinus activation
• mitral isthmus

Partial Coronary Sinus Disconnection During Atrial Tachycardia. Introduction: Persistent atrial fibrillation (AF) ablation may lead to partial disconnection of the coronary sinus (CS). As a result, disparate activation sequences of the local CS versus contiguous left atrium (LA) may be observed during atrial tachycardia (AT). We aimed to evaluate the prevalence of this phenomenon and its impact on activation mapping. Methods: AT occurring after persistent AF ablation were investigated in 74 consecutive patients. Partial CS disconnection during AT was suspected when double potentials with disparate activation sequences were observed on the CS catheter. Endocardial mapping facing CS bipoles was performed to differentiate LA far-field from local CS potentials. Results: A total of 149 ATs were observed. Disparate LACS activations were apparent in 20 ATs after magnifying the recording scale (13%). The most common pattern (90%) was distal to proximal endocardial LA activation against proximal to distal CS activation, the latter involving the whole CS or its distal part. Perimitral macroreentry was more common when disparate LACS activations were observed (67% vs 29%; P = 0.002). Partial CS disconnection also resulted in pseudo mitral isthmus (MI) block during LA appendage pacing in 20% of patients as local CS activation was proximal to distal despite distal to proximal activation of the contiguous LA. Conclusion: Careful analysis of CS recordings during AT following persistent AF ablation often reveals disparate patterns of activation. Recognizing when endocardial LA activation occurs in the opposite direction to the more obvious local CS signals is critical to avoid misleading interpretations during mapping of AT and evaluation of MI block. (J Cardiovasc Electrophysiol, Vol. 23, pp. 697-707, July 2012)

• 出版日期2012-7
• 单位河南工业大学