BACKGROUND: The role of coronary perfusion in the maintenance of atrial fibrillation (AF) electrical sources that anchor to the posterior (wall of the) left atrium (PLA) has been incompletely investigated. We hypothesized that the PLA-pulmonary vein region is perfused by branches originating from both the right and left coronary arteries. OBJECTIVE: The purpose of this study was to evaluate whether branches originating from the right and left coronary arteries could serve as conduits to chemically ablate restricted PLA regions. METHODS: In Langendorff-perfused sheep hearts, the right anterior and left anterior atrial arteries (RAAA and LAAA) and the branches of the left circumflex artery (LCX) were identified as main coronary artery branches perfusing the atria. During sustained AF, 20-mL boluses of cold Tyrode's solution (4°C) was injected into each artery to determine changes in dominant frequency. The injection that yielded the largest dominant frequency decrease indicated the coronary branch to be subsequently perfused with ethanol. Ethanol was selectively injected into the LAAA (n = 4), LCX (n = 4), or RAAA (n = 1). RESULTS: Six of nine AF cases rapidly terminated upon ethanol perfusion. In those hearts and in eight additional preparations (n = 17), Congo red and Evans blue was subsequently perfused into the remaining atrial branches. The perfusion territories were classified as triple-vessel PLA perfusion (n = 4), LAAA-dominant PLA perfusion (n = 5), balanced double-vessel PLA perfusion (n = 5), and LCX or RAAA dominant (n = 3). CONCLUSION: PLA coronary perfusion relies on a variable contribution of right and left coronary branches. Regional irrigation of ethanol in well-delineated PLA perfusion territories enabled ablation of high-frequency sites during AF.
BACKGROUND: The role of coronary perfusion in the maintenance of atrial fibrillation (AF) electrical sources that anchor to the posterior (wall of the) left atrium (PLA) has been incompletely investigated. We hypothesized that the PLA-pulmonary vein region is perfused by branches originating from both the right and left coronary arteries. OBJECTIVE: The purpose of this study was to evaluate whether branches originating from the right and left coronary arteries could serve as conduits to chemically ablate restricted PLA regions. METHODS: In Langendorff-perfused sheep hearts, the right anterior and left anterior atrial arteries (RAAA and LAAA) and the branches of the left circumflex artery (LCX) were identified as main coronary artery branches perfusing the atria. During sustained AF, 20-mL boluses of cold Tyrode's solution (4°C) was injected into each artery to determine changes in dominant frequency. The injection that yielded the largest dominant frequency decrease indicated the coronary branch to be subsequently perfused with ethanol. Ethanol was selectively injected into the LAAA (n = 4), LCX (n = 4), or RAAA (n = 1). RESULTS: Six of nine AF cases rapidly terminated upon ethanol perfusion. In those hearts and in eight additional preparations (n = 17), Congo red and Evans blue was subsequently perfused into the remaining atrial branches. The perfusion territories were classified as triple-vessel PLA perfusion (n = 4), LAAA-dominant PLA perfusion (n = 5), balanced double-vessel PLA perfusion (n = 5), and LCX or RAAA dominant (n = 3). CONCLUSION: PLA coronary perfusion relies on a variable contribution of right and left coronary branches. Regional irrigation of ethanol in well-delineated PLA perfusion territories enabled ablation of high-frequency sites during AF.
Authors: Hakan Oral; Carlo Pappone; Aman Chugh; Eric Good; Frank Bogun; Frank Pelosi; Eric R Bates; Michael H Lehmann; Gabriele Vicedomini; Giuseppe Augello; Eustachio Agricola; Simone Sala; Vincenzo Santinelli; Fred Morady Journal: N Engl J Med Date: 2006-03-02 Impact factor: 91.245
Authors: Frédéric Sacher; Kristi H Monahan; Stuart P Thomas; Neil Davidson; Pedro Adragao; Prashanthan Sanders; Mélèze Hocini; Yoshihide Takahashi; Martin Rotter; Thomas Rostock; Li-Fern Hsu; Jacques Clémenty; Michel Haïssaguerre; David L Ross; Douglas L Packer; Pierre Jaïs Journal: J Am Coll Cardiol Date: 2006-06-20 Impact factor: 24.094
Authors: M Haïssaguerre; P Jaïs; D C Shah; A Takahashi; M Hocini; G Quiniou; S Garrigue; A Le Mouroux; P Le Métayer; J Clémenty Journal: N Engl J Med Date: 1998-09-03 Impact factor: 91.245
Authors: James A McCaffrey; Bishnu P Dhakal; Ashwin S Nathan; Juan Ortega-Legaspi; Paul N Fiorilli; Paul J Mather; Gregory E Supple Journal: JACC Case Rep Date: 2022-07-20
Authors: Uma Mahesh R Avula; Jonathan J Hernandez; Masatoshi Yamazaki; Carmen R Valdivia; Antony Chu; Alvaro Rojas-Pena; Kuljeet Kaur; Roberto Ramos-Mondragón; Justus M Anumonwo; Stanley Nattel; Héctor H Valdivia; Jérôme Kalifa Journal: Circ Arrhythm Electrophysiol Date: 2018-03