Dec 13, 1997

Progressive anterior ablation in the coronary sinus region: evidence to support the presence of a 'slow pathway' input in normal patients?

A D KrahnJ K Lee


AV node modification is an emerging approach to rate control in patients with medically refractory atrial fibrillation. The mechanism of benefit of this procedure is not completely understood. Twenty-two patients (age, 65+/-11 years; 16 women) with medically refractory paroxysmal atrial fibrillation referred for complete AV node ablation underwent serial ablations beginning at the level of the coronary sinus os progressing in a superior and anterior direction toward the His bundle. Serial atrial extrastimulus testing was performed to determine the effect of the progressive posteroseptal ablation in the region of the coronary sinus on the AV node antegrade refractory curve. Two of 22 patients had antegrade dual AV node pathways before ablation. Three patterns of response to serial ablation were noted. In 10 patients (45%), loss of the terminal portion of the AV node antegrade refractory curve occurred without evidence of fast pathway injury. In 7 patients (32%) the curve was shifted upward and to the left, consistent with nonspecific AV node damage. In 5 patients (23%), no effect could be attained before induction of complete AV block at superior and anterior ablation sites. Clinical variables and site of ablation did not predic...Continue Reading

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Mentioned in this Paper

Biochemical Pathway
Coronary Sinus Structure
Refractory Period, Electrophysiological
Atrial Fibrillation
Atrioventricular Block
Neural Pathways
Structure of Atrioventricular Node
Bundle of His
Testicular Neoplasms
Heart Atrium

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