Coronary artery fistula from the left circumflex to the coronary sinus. (1/174)

A 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare.  (+info)

Thoracic vein arrhythmias. (2/174)

The thoracic veins are important foci for the genesis of ectopic atrial tachycardia and play a critical role in the pathophysiology of paroxysmal and permanent atrial fibrillation. The pulmonary veins have the highest arrhythmogenic activity and other venous structures (eg, superior vena cava, coronary sinus and ligament of Marshall) have also been shown arrhythmogenic potential. Thoracic veins contain cardiomyocytes with distinct electrical activities and complex anatomical structures. This review summaries the current understanding of the basic and clinical electrophysiology of thoracic vein arrhythmias.  (+info)

Catheter ablation therapy for atrial fibrillation: current advancements in strategies. (3/174)

Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity and mortality. The circumferential pulmonary vein isolation technique is established as the principal procedure, with a high cure rate and acceptable safety, for paroxysmal AF, but new adjunctive ablation strategies targeting the AF substrates and sources for long-standing persistent/chronic AF have been developed. These new techniques include linear ablation, complex fractionated atrial electrogram guided ablation, dominant frequency map-guided ablation, ganglionated plexi ablation and disconnection of the coronary sinus and superior vena cava to ablate the AF substrates and sources. The long-term usefulness of the established technique and these innovative adjunctive approaches for the treatment of AF remains to be investigated.  (+info)

A novel technique for placement of coronary sinus pacing leads in cardiac resynchronization therapy. (4/174)

A new technique for the placement of left ventricular pacing leads in the tributaries of the coronary sinus (CS) is described. Antegrade visualization of the CS is accomplished by selective coronary angiography, and a hydrophilic 0.032 in. wire is advanced along the CS. This facilitates the advancement of a CS sheath over a multipurpose diagnostic catheter. A hydrophilic angioplasty wire is then utilized for the negotiation of the inferior left ventricular vein and successful placement of the left ventricular pacing lead.  (+info)

Stabilization of the coronary sinus lead position with permanent stylet to prevent and treat dislocation. (5/174)

AIMS: Coronary sinus (CS) leads used for cardiac resynchronization have undergone development in the last years. However, dislocation rate remained high. We explain a simple method to stabilize the CS lead position. METHODS AND RESULTS: Thirty-five patients (11 females, aged 60 +/- 9.2 years) were treated with this method. An over-the-wire left ventricular (LV) pacing lead system was introduced and lodged in the vessel. Then, a stiff stylet was inserted and kept into the CS lead and end of the stylet was cut by a scissor (permanent stylet technique). Pacing and sensing properties of all leads were checked and the guiding sheath was removed. Control echocardiography did not show pericardial effusion. The mean LVpacing threshold was 1.2 +/- 0.8 V and the mean impedance was 625 +/- 143 Omega at the implantation. During follow-up (12.5 +/- 2.5 months), there were no statistically significant changes in pacing threshold and impedance when compared with the implantation measurements. At the last patient visit, the mean LV pacing threshold was 1.1 +/- 0.8 V and the mean impedance was 620 +/- 140 Omega. Impedance measurements did not suggest lead insulation failure. No LV lead dislocations were detected in our 35 cases during the follow-up. CONCLUSION: Permanent stylet technique seems to be a safe and effective procedure to stabilize CS lead position as demonstrated by our 1-year long follow-up results.  (+info)

A novel method of multisite atrial pacing, incorporating Bachmann's bundle area and coronary sinus ostium, for electrical atrial resynchronization in patients with recurrent atrial fibrillation. (6/174)

AIMS: The aim of the study was to assess efficacy and safety of a novel method of multisite atrial pacing, incorporating Bachmann's bundle (BB) and coronary sinus (CS) ostium pacing, which was implemented for the first time in atrial fibrillation (AF) patients with intra-atrial conduction delay. METHODS AND RESULTS: This follow-up study included 97 patients with drug refractory symptomatic AF, sinus node dysfunction, sinus P-wave > or = 120 ms, and normal atrioventricular conduction. Pacing efficacy was assessed on the basis of two main endpoints: successful rhythm control and the absence of documented or symptomatic AF. During the mean 2.3 +/- 0.7 years of follow-up, the survival rate was 99%, pacing maintenance rate 97%, and the need for re-operation 5%. Rhythm control efficacy was 90%, and 14 patients had no evidence of recurrent AF. After implantation, the mean number of anti-arrhythmic drugs used (P < 0.0001), the need for cardioversion (P < 0.01), and the incidence (P < 0.0001) and duration (P < 0.001) of AF-related hospitalizations decreased. P-wave duration with multisite atrial pacing was shorter than during sinus rhythm, BB, and CS pacing (P < 0.0001). CONCLUSION: A novel method of multisite atrial pacing is safe, provides effective long-term rhythm control, and decreases the necessity for adjunctive therapies in patients with refractory AF and intra-atrial conduction delay.  (+info)

Anatomic relations of the Marshall vein: importance for catheterization of the coronary sinus in ablation procedures. (7/174)

AIMS: Our objective was to study the anatomic relations of the human left atrial oblique vein (Marshall vein), particularly of its ostium opening into the coronary sinus, in order to guide ablation procedures related to that vein. METHODS AND RESULTS: The study was carried out in 23 heart-specimens (mean weight 446 +/- 204 g) of individuals whose mean ages were 43 +/- 21 years, 20 males. The coronary sinus was opened longitudinally, exposing the ostium of the tributary veins; the Vieussens valve was looked for, as well as its relationship to the left atrial oblique vein. The diameters of the left atrial oblique vein and the coronary sinus ostia were measured and the distance between them was determined. The left atrial oblique vein could be identified in 20 (87%) of the hearts, while the Vieussens valve was present in 17 (74%) of the specimens (in 16 of which the left atrial oblique vein was identified). In such condition, the vein was adjacent to the Vieussens valve and proximally positioned relative to the coronary sinus ostium in most of them (14/16 cases). The mean diameters of the left atrial oblique vein and of the coronary sinus ostia were, respectively, 1.23 +/- 0.38 and 8.22 +/- 1.88 mm. The mean distance between both ostia was 30.9 +/- 10.2 mm. CONCLUSION: When present, the left atrial oblique vein can be easily recognized, adjacent to the Vieussens valve. The mean distance between the coronary sinus opening and left atrial oblique vein ostium was around 30 mm, independently of the heart weight and the presence of cardiomegaly.  (+info)

Functional bundle branch block and orthodromic reciprocating tachycardia cycle length: do not bet on accessory pathway location. (8/174)

AIMS: To show 2 examples in which the analysis of the effect of bundle branch block on orthodromic reciprocating tachycardia cycle length was misleading. METHODS AND RESULTS: We performed an electrophysiological study in two patients with orthodromic reciprocating tachycardia showing a transition from wide to narrow QRS during tachycardia. Our two cases of left bundle branch block during reciprocating tachycardia using infero-septal pathways show that ventricular to atrial conduction time prolongation may be larger than 30 ms and may be concealed by a shortening of atrial to ventricular conduction time. In the 2 cases, the atrial insertion of the accessory pathway could be successfully ablated from the right atria at the ostium of the coronary sinus. CONCLUSIONS: The observation of the association between left bundle branch block and cycle length prolongation during reciprocating tachycardia may be associated with a successful ablation at the ostium of the coronary sinus.  (+info)