Abstract 13450: Evidence of Left Atrial Appendage Isolation via the Coronary Sinus: Mechanism and Clinical Implications
Introduction: Catheter ablation of adjunctive atrial sites together with pulmonary veins isolation is required in some patients to improve the procedural success rate. AF triggers within the coronary sinus (CS) have been recognized as a potential source of atrial fibrillation. The aim of our study is to report unusual pattern of left atrial appendage isolation with ablation in the coronary sinus.
Methods: 244 consecutive patients undergoing catheter ablation for persistent or long standing persistent AF and showing firing from the coronary sinus have been enrolled in this multicenter prospective study. In all patients defragmentation of the coronary sinus to achieve isolation was attempted both with endocardial and epicardial ablation. During coronary sinus ablation, the circular mapping catheter was positioned into the left atrial appendage.
Results: The baseline clinical characteristics were 66% male, 63±7 years, LA size 47±8mm, AF duration 75±64 months, 32% persistent, and 68% long standing persistent. In 7% of those cases (17 pts) during ablation in the mid coronary sinus simultaneous isolation of the left atrial appendage was documented. This was associated with the presence of a venous branch connecting the coronary sinus with the left atrial appendage. No periprocedural complications were reported.
Conclusion: The results of our study highlight the presence of a distinct electrical connection between the coronary sinus and the left atrial appendage. Because of this, ablation in the mid coronary sinus can result in inadvertent isolation of the left atrial appendage. Considering the potential long term implications, ablation in the mid coronary sinus should prompt assessment of LAA conduction.
- © 2011 by American Heart Association, Inc.