Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation

Luigi Di Biase, Jorge E. Romero, David Briceno, Miguel Valderrabano, Javier E. Sanchez, Domenico G. Della Rocca, Prasant Mohanty, Rodney Horton, G. Joseph Gallinghouse, Sanghamitra Mohanty, Chintan Trivedi, Salwa Beheiry, Carola Gianni, Claude S. Elayi, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

Abstract

Background: Atrial fibrillation (AF) triggers within the coronary sinus (CS)/great cardiac vein (GCV) and the left atrial appendage (LAA) have been recognized as nonpulmonary vein triggers of AF. Objective: The aim of this study was to describe an electrical connection between the LAA and CS/GCV and its importance in achieving LAA electrical isolation (LAAEI). Methods: A total of 488 consecutive patients undergoing catheter ablation for persistent or long-standing persistent AF who showed firing from the LAA and/or from the CS/GCV were enrolled in this multicenter prospective study. In all patients, potential defragmentation of the CS/GCV to achieve isolation and LAAEI was attempted with both endocardial and epicardial ablation. Results: In 7% (n = 34) of these patients, after attempting endocardial LAAEI, the LAA was isolated during epicardial ablation in the GCV. In 8% (n = 39) of patients after attempting endocardial LAA isolation, the LAA was isolated during ablation along the endocardial aspect of the GCV. The presence of a venous branch connecting the GCV with the LAA was found in all these patients. In 23% (n = 112) of patients, the isolation of the LAA also isolated the GCV. In all these patients, LAA dissociated firing was present together with the CS/GCV recordings. Conclusion: These findings suggest the presence of a distinct electrical connection between the GCV and the LAA. The clinical relevance of our results requires further investigation. Ablation in the CS/GCV can result in inadvertent isolation of the LAA. Ablation of the GCV is relevant to achieve LAAEI. Considering the potential long-term implications, ablation in the distal CS/GCV should prompt assessment of LAA conduction.

Original languageEnglish (US)
Pages (from-to)1039-1046
Number of pages8
JournalHeart Rhythm
Volume16
Issue number7
DOIs
StatePublished - Jul 1 2019

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Atrial Appendage
Catheter Ablation
Atrial Fibrillation
Veins
Coronary Sinus
Patient Isolation
Multicenter Studies

Keywords

  • Coronary sinus
  • Great cardiac vein
  • Left trial appendage
  • Long-standing persistent atrial fibrillation
  • Persistent atrial fibrillation
  • Radiofrequency ablation
  • Vein of Marshall

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation. / Di Biase, Luigi; Romero, Jorge E.; Briceno, David; Valderrabano, Miguel; Sanchez, Javier E.; Della Rocca, Domenico G.; Mohanty, Prasant; Horton, Rodney; Gallinghouse, G. Joseph; Mohanty, Sanghamitra; Trivedi, Chintan; Beheiry, Salwa; Gianni, Carola; Elayi, Claude S.; Burkhardt, J. David; Natale, Andrea.

In: Heart Rhythm, Vol. 16, No. 7, 01.07.2019, p. 1039-1046.

Research output: Contribution to journalArticle

Di Biase, L, Romero, JE, Briceno, D, Valderrabano, M, Sanchez, JE, Della Rocca, DG, Mohanty, P, Horton, R, Gallinghouse, GJ, Mohanty, S, Trivedi, C, Beheiry, S, Gianni, C, Elayi, CS, Burkhardt, JD & Natale, A 2019, 'Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation', Heart Rhythm, vol. 16, no. 7, pp. 1039-1046. https://doi.org/10.1016/j.hrthm.2019.02.009
Di Biase, Luigi ; Romero, Jorge E. ; Briceno, David ; Valderrabano, Miguel ; Sanchez, Javier E. ; Della Rocca, Domenico G. ; Mohanty, Prasant ; Horton, Rodney ; Gallinghouse, G. Joseph ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Beheiry, Salwa ; Gianni, Carola ; Elayi, Claude S. ; Burkhardt, J. David ; Natale, Andrea. / Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation. In: Heart Rhythm. 2019 ; Vol. 16, No. 7. pp. 1039-1046.
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abstract = "Background: Atrial fibrillation (AF) triggers within the coronary sinus (CS)/great cardiac vein (GCV) and the left atrial appendage (LAA) have been recognized as nonpulmonary vein triggers of AF. Objective: The aim of this study was to describe an electrical connection between the LAA and CS/GCV and its importance in achieving LAA electrical isolation (LAAEI). Methods: A total of 488 consecutive patients undergoing catheter ablation for persistent or long-standing persistent AF who showed firing from the LAA and/or from the CS/GCV were enrolled in this multicenter prospective study. In all patients, potential defragmentation of the CS/GCV to achieve isolation and LAAEI was attempted with both endocardial and epicardial ablation. Results: In 7{\%} (n = 34) of these patients, after attempting endocardial LAAEI, the LAA was isolated during epicardial ablation in the GCV. In 8{\%} (n = 39) of patients after attempting endocardial LAA isolation, the LAA was isolated during ablation along the endocardial aspect of the GCV. The presence of a venous branch connecting the GCV with the LAA was found in all these patients. In 23{\%} (n = 112) of patients, the isolation of the LAA also isolated the GCV. In all these patients, LAA dissociated firing was present together with the CS/GCV recordings. Conclusion: These findings suggest the presence of a distinct electrical connection between the GCV and the LAA. The clinical relevance of our results requires further investigation. Ablation in the CS/GCV can result in inadvertent isolation of the LAA. Ablation of the GCV is relevant to achieve LAAEI. Considering the potential long-term implications, ablation in the distal CS/GCV should prompt assessment of LAA conduction.",
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T1 - Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation

AU - Di Biase, Luigi

AU - Romero, Jorge E.

AU - Briceno, David

AU - Valderrabano, Miguel

AU - Sanchez, Javier E.

AU - Della Rocca, Domenico G.

AU - Mohanty, Prasant

AU - Horton, Rodney

AU - Gallinghouse, G. Joseph

AU - Mohanty, Sanghamitra

AU - Trivedi, Chintan

AU - Beheiry, Salwa

AU - Gianni, Carola

AU - Elayi, Claude S.

AU - Burkhardt, J. David

AU - Natale, Andrea

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Atrial fibrillation (AF) triggers within the coronary sinus (CS)/great cardiac vein (GCV) and the left atrial appendage (LAA) have been recognized as nonpulmonary vein triggers of AF. Objective: The aim of this study was to describe an electrical connection between the LAA and CS/GCV and its importance in achieving LAA electrical isolation (LAAEI). Methods: A total of 488 consecutive patients undergoing catheter ablation for persistent or long-standing persistent AF who showed firing from the LAA and/or from the CS/GCV were enrolled in this multicenter prospective study. In all patients, potential defragmentation of the CS/GCV to achieve isolation and LAAEI was attempted with both endocardial and epicardial ablation. Results: In 7% (n = 34) of these patients, after attempting endocardial LAAEI, the LAA was isolated during epicardial ablation in the GCV. In 8% (n = 39) of patients after attempting endocardial LAA isolation, the LAA was isolated during ablation along the endocardial aspect of the GCV. The presence of a venous branch connecting the GCV with the LAA was found in all these patients. In 23% (n = 112) of patients, the isolation of the LAA also isolated the GCV. In all these patients, LAA dissociated firing was present together with the CS/GCV recordings. Conclusion: These findings suggest the presence of a distinct electrical connection between the GCV and the LAA. The clinical relevance of our results requires further investigation. Ablation in the CS/GCV can result in inadvertent isolation of the LAA. Ablation of the GCV is relevant to achieve LAAEI. Considering the potential long-term implications, ablation in the distal CS/GCV should prompt assessment of LAA conduction.

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KW - Coronary sinus

KW - Great cardiac vein

KW - Left trial appendage

KW - Long-standing persistent atrial fibrillation

KW - Persistent atrial fibrillation

KW - Radiofrequency ablation

KW - Vein of Marshall

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