Coronary Sinus Isolation: Evidence for Discrete CS-LA Connections

Abstract

CS has muscular sheaths which connect it to atria. A 44 year old man with longstanding persistant AF had his previous ablation that included wide encircling PV antrum, roof line and endo-epicardial mitral isthmus (MI) ablation. Two years later he had recurrence of arrhythmia. PVs were reconsolidated, and roofline and MI block were confirmed. Atrial pacing induced a regular tachycardia (CL 340ms) with proximal to distal CS activation. Activation and entrainment mapping in LA, RA and CS were suggestive of focal atrial tachycardia with earliest activation in anterior LA just superior to line of MI block. Activation in proximal CS was medial to lateral and in high lateral CS (lateral of the isth..