Comparison of Coronary Sinus Morphology in Patients With and Without Atrioventricular Nodal Reentrant Tachycardia by Intracardiac Echocardiography

Okumura, Yasuo; Watanabe, Ichiro; Yamada, Takeshi; Ohkubo, Kimie; Masaki, Riko; Sugimura, Hidezou; Hashimoto, Kazuhito; Kofune, Tatsuya; Takagi, Yasuhiro; Wakita, Rie; Oshikawa, Naohiro; Saito, Satoshi; Ozawa, Yukio; Kanmatsuse, Katsuo; Yoshikawa, Yasuyuki; Asakawa, Yuko

doi:10.1046/j.1540-8167.2004.03114.x

Cited by 30 publications

(26 citation statements)

References 8 publications

(19 reference statements)

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“…An increase in the length of the posterior extension of the AV node and slow pathway has been associated with an increase in the width of the coronary sinus os and might predispose to AVNRT possibly by increasing the length of the posterior extension of AV nodal slow pathway. However, this anatomic finding that has been reported to be noted more commonly in patients with AVNRT was not more common in women (10).…”

Section: Physiologic Basis For Clinical Clues To Svt Diagnosiscontrasting

confidence: 44%

Diagnosing the Mechanism of Supraventricular Tachycardia

Marchlinski

2009

Journal of the American College of Cardiology

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Section: Physiologic Basis For Clinical Clues To Svt Diagnosiscontrasting

confidence: 44%

Diagnosing the Mechanism of Supraventricular Tachycardia

Marchlinski

2009

Journal of the American College of Cardiology

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“…Lesions are usually created from the right side of the septum in the inferior or mid segment of the triangle of Koch [1–6], although the precise site of successful ablation is found over a wide midseptal or posteroseptal region [1, 5–7]. Some clinical investigators have suggested that the highly variable sizes and shapes of Koch’s triangle [8–10], and size and morphology of the coronary sinus (CS) ostium [11, 12], contribute to the variability in the location of successful ablation sites among patients. In particular, there are anatomic variations in the right posterior extension of the AV node, which act as SP during ongoing AVNRT [13], although neither their location relative to Koch’s triangle or the CS ostium nor the length of the SP (SP-L) have been evaluated clinically.…”

Section: Introductionmentioning

confidence: 99%

“…The identification of the precise anatomic location of SP is likely to optimize the safety of its ablation. Moreover, the methodological determinants of this individual variability in previous studies might be explained, at least in part, by the limited accuracy of fluoroscopy in identifying anatomic landmarks and the optimal ablation site [1, 5–7, 9–12, 14–16]. An electroanatomic mapping system (EAMS) might precisely track the tip of the mapping catheter and accurately measure the distance between two points in a three-dimensional space [17, 18].…”

Section: Introductionmentioning

confidence: 99%

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

et al. 2013

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The length of the slow pathway (SP-L) in atrioventricular (AV) nodal reentrant tachycardia (NRT) has never been measured clinically. We studied the relationship among (a) SP-L, i.e., the distance between the most proximal His bundle (H) recording and the most posterior site of radiofrequency (RF) delivery associated with a junctional rhythm, (b) the length of Koch’s triangle (Koch-L), (c) the conduction time over the slow pathway (SP-T), measured by the AH interval during AVNRT at baseline, and (d) the distance between H and the site of successful ablation (SucABL-L) in 26 women and 20 men (mean age 64.6 ± 11.6 years), using a stepwise approach and an electroanatomic mapping system (EAMS). SP-L (15.0 ± 5.8 mm) was correlated with Koch-L (18.6 ± 5.6 mm; R2 = 0.1665, P < 0.005), SP-T (415 ± 100 ms; R2 = 0.3425, P = 0.036), and SucABL-L (11.6 ± 4.7 mm; R2 = 0.5243, P < 0.0001). The site of successful ablation was located within 10 mm of the posterior end of the SP in 38 patients (82.6 %). EAMS-guided RF ablation, using a stepwise approach, revealed individual variations in SP-L related to the size of Koch’s triangle and AH interval during AVNRT. Since the site of successful ablation was also correlated with SP-L and was usually located near the posterior end of the SP, ablating anteriorly, away from the posterior end, is not a prerequisite for the success of ablation procedures.

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“…Thus, even if both arrhythmias have a common area of the perinodal atrium in their tachycardia circuit, the width of the AFL circuit at the septal cavotricuspid isthmus should be larger than slow pathway location because of the wider, "windsock" appearance of the coronary sinus ostium in patients with AVNRT. 12 However, inducibility of AFL in patients with AVNRT may not predict spontaneous onset of AFL in the future.…”

Section: Resultsmentioning

confidence: 99%

“…12 If the same area is critical for AVNRT and AFL, AFL might be inducible in patients with AVNRT. Therefore, the purpose of this study was to evaluate the inducibility of AFL in patients with AVNRT and to determine if the inducibility of AFL is altered by RFCA of the slow pathway of the AVNRT circuit.…”

Section: Circulation Journal Vol70 September 2006mentioning

confidence: 99%

Inducibility of Atrial Flutter in Patients With Atrioventricular Nodal Reentrant Tachycardia

Takagi

Watanabe

Okumura

et al. 2006

Circ J

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revious studies have shown that typical atrial flutter (AFL) is caused by a reentrant circuit confined to the right atrium. 1,2 Percutaneous catheter mapping studies have shown that the reentrant circuit includes an area of slow conduction bounded on the lateral side by the septal leaflet of the tricuspid valve and the inferior vena cava (lateral isthmus) and on the medial side by the Eustachian valve/ridge and the septal leaflet of the tricuspid valve (medial isthmus) and the coronary sinus ostium and the septal leaflet of the tricuspid valve (septal isthmus). 1-5 Typical atrioventricular nodal reentrant tachycardia (AVNRT) has a dual atrioventricular (AV) nodal pathway physiology and can be cured by radiofrequency catheter ablation (RFCA). The "slow pathway" is thought to have a predominantly posterior -inferior location between the coronary sinus ostium and the septal leaflet of the tricuspid valve, and the "fast pathway" allegedly starts in the anterior -superior portion of the interatrial septum. [6][7][8][9][10] On the basis of a postmortem study, Inoue and Becker reported that the human compact AV node contains rightward and leftward posterior extensions, with the rightward extension close to the tricuspid annulus. They concluded that these extensions are involved in "slow pathway" conduction 11 (Fig 1). Furthermore, we recently showed by 3-dimensional reconstruction Circulation Journal Vol.70, September 2006from intracardiac ultrasonographic images that the coronary sinus is significantly larger in patients with AVNRT than in those without. 12 If the same area is critical for AVNRT and AFL, AFL might be inducible in patients with AVNRT. Therefore, the purpose of this study was to evaluate the inducibility of AFL in patients with AVNRT and to determine if the inducibility of AFL is altered by RFCA of the slow pathway of the AVNRT circuit. Methods SubjectsThe subjects of the study were 170 consecutive Japanese patients (80 men, 90 women; mean age 49±16 years) referred to Nihon University Hospital for RFCA of supraventricular tachycardia: 71 patients with inducible AVNRT and 99 control patients consisting of 14 patients with atrial tachycardia, 60 patients with manifest Wolff-ParkinsonWhite (WPW) syndrome and 25 patients with concealed WPW syndrome. No patient had a history of spontaneous AFL prior to the electrophysiological study. Age, sex and body surface area in the AVNRT group and in the group of patients with other types of supraventricular tachycardia are detailed in Table 1. No patient had structural heart disease. Each patient completed a signed consent form for participation in the study and ablation therapy. Twenty four patients with clinical history of AFL (21 men, mean age 67.0±9.2 years) were also included in this study to compare the cycle length (CL) of the AFL. Electrophysiologic TestingIn all patients, antiarrhythmic drug therapy was discon- Background Previous studies have shown that both atrioventricular nodal reentrant tachycardia (AVNRT) and atrial flutter (AFL) have an area of slow co...

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Comparison of Coronary Sinus Morphology in Patients With and Without Atrioventricular Nodal Reentrant Tachycardia by Intracardiac Echocardiography

Abstract: The CS os was significantly wider in patients with AVNRT than in those without. These findings may have important implications for arrhythmia pathogenesis in AVNRT as well as AFL.

Cited by 30 publications

References 8 publications

Diagnosing the Mechanism of Supraventricular Tachycardia

Diagnosing the Mechanism of Supraventricular Tachycardia

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Inducibility of Atrial Flutter in Patients With Atrioventricular Nodal Reentrant Tachycardia

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