Atrial macroreentry involving the myocardium of the coronary sinus: A unique mechanism for atypical flutter

Jeffrey E. Olgin, J. Vijay Jayachandran, Erica Engesstein, William Groh, Douglas P. Zipes

Research output: Contribution to journalArticle

114 Scopus citations

Abstract

Atrial flutter involving either clockwise or counterclockwise rotation around the tricuspid annulus utilizing the subeustachian isthmus has been well described. However, macroreentrant atrial circuits in atypical atrial flutter in patients who have not undergone previous surgery or without atrial disease are not well defined. We describe a patient without structural heart disease who presented with an atrial macroreentrant rhythm. Entrainment mapping demonstrated a critical isthmus within the coronary sinus. Activation mapping demonstrated double potential throughout the length of the coronary sinus with disparate activation sequences. A circuit involving the myocardium of the coronary sinus, exiting in the lateral left atrium, down the interatrial septum, and reentering into the coronary sinus was identified. Successful ablation of the rhythm was accomplished by a circumferential radiofrequency application within the coronary sinus.

Original languageEnglish (US)
Pages (from-to)1094-1099
Number of pages6
JournalJournal of cardiovascular electrophysiology
Volume9
Issue number10
DOIs
StatePublished - 1998

Keywords

  • Ablation
  • Atrial flutter
  • Atrial tachycardia
  • Atrium
  • Coronary sinus
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

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