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At least 775 records · Page 43Linked to original sources
PubMed2006

Radiofrequency catheter ablation within the coronary sinus eliminates a macro-reentrant atrial tachycardia: importance of mapping in the coronary sinus.

We describe a patient who underwent radiofrequency (RF) catheter ablation of symptomatic atrial fibrillation. After left atrial (LA) catheter ablation and pulmonary vein isolation, a macro-reentrant atrial tachycardia (AT) with a critical isthmus at the mitral isthmus was induced by incremental atrial pacing from the coronary sinus. Extensive RF energy applications from endocardial sites using ablation catheters with 4 mm- and 8 mm- tips resulted in no discrete potentials being recorded from the endocardial sites of the isthmus, but the tachycardia could not be terminated. However, discrete potentials were recorded within the CS, and epicardial RF energy applications from the CS eliminated the tachycardia. Thus, mapping in the CS is useful for detecting residual conduction at epicardial sites along the mitral isthmus. RF catheter ablation within the CS should be considered when no distinct electrograms are recorded after extensive ablation from the endocardial sites and when distinct electrograms are recorded within the CS.

Atrial Fibrillation↗
PubMed2005

Intermittent coronary sinus occlusion complicating coronary sinus cannulation during coronary artery bypass operation.

Coronary sinus (CS) thrombosis is a rare event, usually complicating invasive procedures that cause trauma to the CS. Based on anecdotal case reports, this pathology is frequently associated with serious complications and is commonly fatal. We describe a case of intermittent CS thrombosis resulting from CS cannulation during coronary artery bypass grafting operation. This complication was further complicated by myocardial infarction, left ventricular free wall rupture, and pseudoaneurysm formation. The characteristic echocardiographic findings and a review of the literature on this rare complication are presented.

Aged↗
PubMed1996

Successful catheter ablation of an inferoseptal accessory pathway within the coronary sinus in a patient with a previously unsuccessful attempt at surgical interruption. Coronary sinus ablation for Wolff-Parkinson-White syndrome.

In a patient with Wolff-Parkinson-White syndrome and a right inferoseptal accessory pathway who had had a previously unsuccessful surgical attempt at accessory pathway ablation, the accessory pathway was found to be adjacent to a branch of the coronary sinus. Radiofrequency energy was delivered within this branch to ablate the pathway successfully. This demonstrates an alternative approach to the more common method of radiofrequency ablation of accessory pathways from a tricuspid or mitral annular location.

Adult↗
PubMed2004

Effect of left atrial-coronary sinus musculature connections on the coronary sinus activation pattern via retrograde conduction in patients with WPW syndrome.

BACKGROUND: Double potential (DP) activation patterns observed in coronary sinus (CS) electrograms recorded during left lateral atrial pacing, were explained by an initial low-frequency left atrial (LA) activation potential and secondary high-frequency CS musculature activation potential in canine hearts. Moreover, the connections between the LA and CS musculature vary greatly in size and location in the human heart. The purpose of this study was to investigate the relationship between the CS activation pattern during retrograde conduction via an accessory pathway (AP) and the location of left-sided APs. METHODS AND RESULTS: Fifty-one patients (31 males, mean age 48.6 years) who underwent radiofrequency catheter ablation of left-sided APs were divided into two groups according to the successful ablation site. The CS electrograms during retrograde AP conduction were classified into 3 types; single, fractionated, and DP activation patterns. A DP pattern was identified in 10 of 12 patients (83.3%) with posteroseptal to posterolateral APs, and in particular, 9 had a divergent sequence. Twenty-six of 39 patients (66.7%) with lateral to anterolateral APs, demonstrated a single pattern. The number of radiofrequency applications was significantly higher in patients with a DP pattern than in those with a single pattern (3.4 +/- 3.3 vs. 7.8 +/- 6.8, p < 0.01). CONCLUSION: Misleading information obtained when mapping for optimal ablation sites might result from DP patterns with a divergent sequence produced by discrete muscular connections between the LA and CS musculature. Ablation around left posterior APs may require meticulous observation of the CS activation patterns.

Action Potentials↗
PubMed1988

Characterization of fetal urogenital sinus-induced prostatic hyperplasia in the mouse: time course, hormonal requirement, age dependency, and responsiveness of various adult organs to growth induction by fetal urogenital sinus tissues.

Mouse prostatic hyperplasia can be induced experimentally by the direct implantation of fetal urogenital sinus (UGS) or its mesenchyme (UGM) tissue in situ. This study characterized the time course, the requirement of sex steroids, and the optimal ages of donor and host tissues necessary to induce the maximal overgrowth of the adult mouse prostate gland in this model system. To test the potential uses of these fetal inductors as general growth-promoting substances for other adult organs, we have also tested directly the activity of fetal UGS in several non-UGS-derived adult organs. These results were compared with the growth-promoting effect achieved by fetal UGM in order to gain further insight into the relative contribution of UGS/UGM in the overall growth responses. Peak DNA synthesis in the implanted prostate occurred at three time periods-Days 4, 7-16, and 35. At Day 4, DNA synthesis may have reflected tissue repair following surgical trauma, but the DNA synthesis on Days 7-16 and 35 is attributable to growth of the chimeric (enlarged) prostate gland. Initiation and maintenance of hyperplasia required testicular androgens. Exogenous testosterone propionate (175 micrograms/day) did not induce additional prostatic overgrowth in intact, sexually mature hosts, but promoted additional overgrowth in immature and pubertal hosts. Exogenous estrogen (17 beta-estradiol dipropionate, 20 micrograms/day) inhibited fetal UGS-induced prostatic overgrowth by inhibiting the hypothalamic-pituitary-testicular axis. UGS derived from fetuses of Days 14, 16, or 18 of gestation had similar growth-inductive capability in intact adult hosts, but this capability was restricted soon after birth.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1996

Earlier activation of the distal than the proximal site of the coronary sinus may represent retrograde conduction through AV node: significance of recording of far distal coronary sinus.

During retrograde conduction through an accessory pathway (AP) or the atrioventricular (AV) node, earlier activation of the distal recording site than a more proximal site of the coronary sinus (CS) generally indicates retrograde conduction via a distally located AP. Thus, after successful ablation of a left-sided AP, if the distal CS recording site is activated earlier than a more proximal site retrogradely, it is considered to suggest-in the absence of His-bundle recording or more frequently in the setting of poor recording of the low septal right atrial electrogram-a conduction via a second AP (located more distally), and not conduction via the AV node. Yet, we hypothesized that retrograde conduction through the AV node may activate the far distal site of the CS (CSD) earlier than a more proximal site, as the anterior atrial wavefront, coming retrogradely from the AV node and traveling along the anterior mitral annulus, could reach the CSD earlier than a more proximal site. To test this we studied 18 patients with intact retrograde conduction via the AV node, but without evidence of an AP. The CSD was recorded by means of a quadripolar catheter (interelectrode distance of 2-5 mm); retrograde activation sequence at the distal (CSD1-2) versus proximal (CSD3-4) bipolar recording site was determined during ventricular stimulation. In 12 of 18 patients the CSD1-2 recording site was activated 5-10 ms earlier than the CSD3-4 recording site, in 3 of 18 patients the CSD1-2 site was activated 5 ms later than the CSD3-4 site; in the remaining 3 patients both recording sites were depolarized simultaneously. The results indicate that the CSD was often depolarized earlier than a more proximal site by impulses that conducted to the atria retrogradely via the AV node while the quadripolar recording catheter was placed at the CSD. This observation, although not well documented previously, suggests that the sequence of retrograde atrial activation in the CS should be studied carefully in consideration of the actual location of the mapping catheter in order to correctly diagnose the presence or absence of conduction via an AP.

Adolescent↗
PubMed2006

Anatomic proximity of the esophagus to the coronary sinus: implication for catheter ablation within the coronary sinus.

INTRODUCTION: The anatomic proximity between the esophagus and the coronary sinus (CS) might render the esophagus vulnerable to thermal injury during ablation. Therefore, we investigated the anatomic relationship between the esophagus and the CS in patients with atrial fibrillation (AF). METHODS AND RESULTS: Thirty patients (25 males, mean age = 54 +/- 11 years) with drug-refractory paroxysmal AF were included. Sixteen-slice multidetector computed tomography was performed to depict the course of the esophagus and relationship to the CS. The esophagus was in direct contact with the CS in 57% (17/30) of patients (group 1). The mean length of the contact was 6.1 +/- 3.4 mm. In the remaining 13 patients, the esophagus did not come in direct contact with the CS (group 2). The shortest distance between the esophagus and the CS was 4.0 +/- 2.6 mm. The CS diameter (9.4 +/- 1.8 vs 8.5 +/- 2.4 mm, P = 0.15), esophagus width (18.6 +/- 1.6 vs 18.6 +/- 1.7 mm, P = 0.87), anteroposterior diameter of the left atrium (35.9 +/- 3.8 vs 35.0 +/- 3.3 mm, P = 0.58), thickness of the anterior wall of the esophagus (2.9 +/- 0.6 vs 2.9 +/- 0.6 mm, P = 0.97), and shortest distance from the esophagus to the CS ostium (19.3 +/- 5.4 vs 25.0 +/- 6.2 mm, P = 0.02) and to the great cardiac vein (8.5 +/- 5.3 vs 12.1 +/- 6.9 mm, P = 0.10) were compared between the two groups. CONCLUSIONS: In 57% of our patients, the esophagus was in direct contact with the CS, and a significantly shorter distance between the esophagus and the CS ostium was noted in these patients. It is important to prevent esophageal damage when applying energy within the CS.

Adult↗