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| Main Authors: | , , , , , , , , , , , |
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| Format: | Artículo Open Access |
| Published: |
Wiley
2025
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| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/pace.70099 |
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Table of Contents:
- Electrophysiological Characteristics of Coronary Sinus Activation Sequence Alteration During Left Lateral AP Ablation Qing Wang Xiangao Ji Xingxing Sun Shaochong Deng Weizhu Ju Gang Yang Kai Gu Hailei Liu Mingfang Li Jing Wang Hongwu Chen Minglong Chen Pacing and Clinical Electrophysiology ABSTRACT Background The occurrence of a left free‐wall (LFW) accessory pathway (AP) with concentric activation sequences in the coronary sinus (CS) during orthodromic atrioventricular reentrant tachycardia (OAVRT) is an uncommon phenomenon. Methods Using three‐dimensional (3D) mapping system in eight patients with LFW‐AP (mean age 44±9.9 years), we systematically analyzed mitral annular (MA) activation during OAVRT. Results The primary location of the APs was in the left lateral region in seven patients. The tachycardia, characterized by varying CS sequences, remained sustainable in three patients and was inducible in four patients following the initial ablation at the earliest retrograde atrial insertions. The tachycardia cycle length (TCL) was comparable to the baseline TCL (345.4±94.2 vs. 345.6±93.4 ms; p = 0.99). Moreover, the tachycardia was terminated by ablating the earliest retrograde atrial activation region adjacent to the initial ablation site. One patient with a history of left lateral AP ablation exhibited mitral isthmus (MI) block, and the left anterior AP was successfully ablated. Following a mean follow‐up of 50.5 months, no recurrence of tachycardia was reported by any patient. Conclusion LFW‐AP with concentric CS activation sequences represents a distinctive electrophysiological entity, our study demonstrates detailed mapping in the vicinity of the MA is imperative to localize the secondary atrial insertion site of the AP or to identify multiple APs in close proximity to the initial ablation site. Clinical Trial Registration This retrospective study does not require clinical trial registration. 10.1111/pace.70099 http://onlinelibrary.wiley.com/termsAndConditions#vor