Coronary Sinus Recordings of Double Potentials Associated with Retrograde Conduction Through Left Atrioventricular Accessory Pathways

Abstract

In patients with connections between the paraseptal CS musculature and left atrium but no connections more laterally, retrograde left AP conduction is associated with double potentials in the CS recordings. The double potentials represent activation of the left atrial insertion of the AP (DP1) and later activation of the CS musculature (DP2) via connections between the paraseptal CS musculature and left atrium, respectively. The activation pattern of DP1 depends on AP location, thus providing important information for AP localization during CS mapping.

Absence of Left Atrium-Coronary Sinus Musculature Electrical Connection at Coronary Sinus Ostium Unmasked by Unique Double Coronary Sinus Potentials Pattern

“…We attributed DP1 and DP2 to the activation of LA and CSM, respectively, on the basis of the following observations: The morphology of DP1 is consistent with a LA "farfield" potential, while that of DP2 is consistent with the activation of the CSM (1,(3)(4)(5)(6). The LA activation earlier than a) the CSM and b) the atrium in the His-bundle region during RVA pacing suggested the presence of an AV AP, rather than a CSM-ventricular AP.…”

“…5, the wavefront of LA (DP1) would reach the ostium of CS, and the wavefront Histological study in humans has shown that myocardial connections between LA and CSM varies greatly in size and location, and no connection or a loose connection in the distal CS is not rare (2). In contrast, the absence of LA-CSM electrical connection in the proximal CS has not ever been reported in a clinical study (3). In our previous study, double potentials were detected in 11 patients of 74 patients (14.9%) with paroxysmal supraventricular tachycardia who underwent successful ablation (3).…”

“…Since multiple CSM-LA connections are generally present (3), CS recordings of retrograde conduction through a left-sided accessory pathway (AP) typically show a single atrial signal, due to fusion of the LA and CSM potentials. However, in some patients, double potentials representing LA and CSM activation are recorded along the CS during retrograde AP conduction only due to a few LA-CSM electrical connections (3). We describe a rare case exhibiting unique double CS potentials which unmasked the absence of a LA-CSM electrical connection at CS ostium.…”

“…Electrophysiological analysis of CS recordings which represent far-field activation of LA and near-field activation of CSM, is useful to investigate CSM-LA electrical connections (3)(4)(5)(6). Since multiple CSM-LA connections are generally present (3), CS recordings of retrograde conduction through a left-sided accessory pathway (AP) typically show a single atrial signal, due to fusion of the LA and CSM potentials.…”

Double potentials at successful catheter ablation site of left-sided retrograde accessory pathway: Mitral isthmus block or conduction through coronary sinus musculature

“…Kasai et al demonstrated connections between left atrium and CS musculature using extrastimulus techniques in the human heart [5]. Akiyama et al reported double potentials associated with retrograde AP conduction caused by left atrium (the first component) and CS musculature activation (the second component) [6].…”