Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence

Róbert Pap, Vassil B. Traykov, Attila Makai, Gábor Bencsik, T. Forster, László Sághy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

CS-Electrograms Guide Posteroseptal/Left Posterior AP Ablation. Introduction: 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.

Original languageEnglish
Pages (from-to)653-658
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number7
DOIs
Publication statusPublished - Jul 2008

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Coronary Sinus
Heart Atria
Cardiac Catheterization
Myocardium

Keywords

  • Accessory pathway
  • Catheter ablation
  • Coronary sinus musculature
  • Left posterior
  • Posteroseptal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. / Pap, Róbert; Traykov, Vassil B.; Makai, Attila; Bencsik, Gábor; Forster, T.; Sághy, László.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 7, 07.2008, p. 653-658.

Research output: Contribution to journalArticle

Pap, Róbert ; Traykov, Vassil B. ; Makai, Attila ; Bencsik, Gábor ; Forster, T. ; Sághy, László. / Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 7. pp. 653-658.
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abstract = "CS-Electrograms Guide Posteroseptal/Left Posterior AP Ablation. Introduction: 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.",
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AU - Makai, Attila

AU - Bencsik, Gábor

AU - Forster, T.

AU - Sághy, László

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AB - CS-Electrograms Guide Posteroseptal/Left Posterior AP Ablation. Introduction: 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.

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