Int J Arrhythm.  2016 Mar;17(1):14-19. 10.18501/arrhythmia.2016.002.

Anatomical Discrepancy Between The Coronary Sinus and the Mitral Annulus by Fluoroscopy

Affiliations
  • 1Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea. hwanggs@medimail.co.kr

Abstract

BACKGROUND AND OBJECTIVES
Intracardiac electrocardiograms (ECGs) from the coronary sinus (CS) provide important information for identifying a left-sided bypass tract. However, a previous study revealed an anatomical discrepancy between the CS and mitral annulus (MA) in cadaver hearts. The purpose of this study was to evaluate the anatomical relationship between the CS and MA in the living body by using fluoroscopy.
SUBJECTS AND METHODS
We analyzed patients who had an ablation for 42 left-sided bypass tracts and one paroxysmal atrial fibrillation. A left atriogram was performed during the ablation by using a pigtail catheter via the transseptal approach. The distances between the CS and MA were measured at 30° right anterior oblique (RAO) and 60° left anterior oblique (LAO) projections at the end of ventricular systole and diastole.
RESULTS
The distances between the CS and MA at the RAO projection were 9.74±3.50, 3.86±2.58, and 9.02±6.04 mm during systole and 12.89±5.59, 3.97±3.24, and 10.71±4.12 mm during diastole at the proximal, middle, and distal CS, respectively. The distances between the CS and MA at the LAO projection were 6.84±2.77, 1.80±1.51, and 4.57±3.24 mm during systole and 9.91±3.25, 4.21±3.59, and 7.02±3.12 mm during diastole at the proximal, middle, and distal CS, respectively.
CONCLUSION
An anatomical discrepancy was detected between the CS and MA in most cases. Therefore, intracardiac ECGs of the CS cannot exactly localize left-sided bypass tracts.

Keyword

Coronary Sinus; Mitral Annulus; Fluoroscopy

MeSH Terms

Atrial Fibrillation
Cadaver
Catheters
Coronary Sinus*
Diastole
Electrocardiography
Fluoroscopy*
Heart
Humans
Systole
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