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Proximity of Right Coronary Artery to Cavotricuspid Isthmus as Determined by Computed Tomography
Author(s) -
AL ALOUL BASEL,
SIGURDSSON GARDAR,
CAN ILKNUR,
LI JIANMINGI,
DYKOSKI RICHARD,
THOLAKANAHALLI VENKATAKRISH.
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.02844.x
Subject(s) - medicine , right coronary artery , endocardium , ablation , radiofrequency ablation , cardiology , atrial flutter , coronary sinus , catheter ablation , coronary angiography , myocardial infarction
Background: Radiofrequency ablation of atrial flutter is a commonly performed procedure. Ablation success depends upon complete transmural atrial tissue injury to achieve bidirectional cavotricuspid isthmus (CTI) block. Transmural ablation increases risk of injury to the adjacent right coronary artery (RCA). Distance between the RCA and the endocardium within the CTI area is not well described. We aimed to perform in vivo measurements of the distance between the CTI area and adjacent RCA.Methods: Thirty‐three consecutive patients underwent electrocardiogram‐gated contrast‐enhanced computed tomography. CTI area was divided into nine segments based on three common catheter locations (paraseptal, central, and lateral or 5, 6, and 7 o'clock) and ventricular to atrial ablation line.Results: Mean age was 64 ± 11 years and 97% of the participants were male. Paraseptal, central, and lateral measurements at the tricuspid annulus ridge showed endocardial to RCA distance 9 ± 3, 6 ± 2, and 5 ± 3 mm, respectively (range 2–17 mm). Corresponding measurements for the ventricular side were 5 ± 3, 4 ± 2, and 4 ± 2 mm and atrial side measurements were 3 ± 2, 3 ± 2, and 3 ± 3 mm. Distance was ≤2 mm in 14% of segments on the ventricular side and 39% of segments on the atrial side. Paired t‐test showed significant difference (P < 0.001) between tricuspid annulus ridge measurements and adjacent atrial or ventricular measurements.Conclusions: Distance between endocardium and RCA lumen is reduced in areas adjacent to the tricuspid annulus ridge. (PACE 2010; 1319–1323)

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