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Ablation of Posteroseptal and Left Posterior Accessory Pathways Guided by Left Atrium–Coronary Sinus Musculature Activation Sequence
Author(s) -
PAP RÓBERT,
TRAYKOV VASSIL B.,
MAKAI ATTILA,
BENCSIK GÁBOR,
FORSTER TAMÁS,
SÁGHY LÁSZLÓ
Publication year - 2008
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2008.01103.x
Subject(s) - medicine , coronary sinus , cardiology , left atrium , accessory pathway , ablation , catheter ablation , anatomy , atrial fibrillation
While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left‐sided approach. “Fragmented” or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. Methods and Results: Forty patients with posteroseptal or left posterior AP were included. The LA–CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A “fragmented” or double “atrial” potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right‐sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. Conclusion: During retrograde AP conduction, the sequence of LA–CS musculature activation—as deduced from analysis of electrograms recorded at the earliest site inside the CS—can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach.