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Atrial coronary arteries in areas involved in atrial fibrillation catheter ablation
Januário Pardo Meo1, Maurício Scanavacca, Eduardo Sosa
1Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Insights
Radiofrequency ablation for atrial fibrillation is limited by nearby blood vessels. This study reveals common major atrial arteries in ablation zones, potentially complicating procedures and causing heart dysfunction.
Area of Science:
- Cardiovascular Anatomy
- Electrophysiology
- Interventional Cardiology
Background:
- Vascular proximity limits radiofrequency ablation efficacy.
- Atrial arterial anatomy is underappreciated in atrial fibrillation ablation development.
Purpose of the Study:
- To investigate the atrial arterial circulation in regions targeted for atrial fibrillation ablation.
- To identify potential vascular complications during catheter ablation procedures.
Main Methods:
- Examination of 24 human heart specimens.
- Colored resin injection and detailed anatomical dissection.
- Analysis of major artery distribution in key ablation areas.
Main Results:
- Sinus node artery (SNA) origin varied (circumflex or right coronary artery).
- Major arteries (≥1mm) were prevalent in the mitral isthmus (54%), LA roof (54%), and anterior wall (29%).
- Significant arterial presence noted around pulmonary vein ostia (up to 37%).
Conclusions:
- Major atrial coronary arteries are frequently encountered during AF ablation.
- These vessels may impede transmural lesion creation and electrical isolation.
- Risk of ischemic sinus node or atrial dysfunction exists due to these arteries.
Background:
The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques.
Methods And Results:
We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection. The sinus node artery (SNA) arose from the circumflex artery in 42% of case; proximal to the LA appendage in 29%, crossing the left atrium (LA) anterior wall; and after the LA appendage in the remaining 13%, crossing the mitral isthmus and passing close to the left pulmonary veins (PVs), the LA roof, and the right superior PV. In 58%, the SNA arose from the right coronary artery. Major arteries (≥ 1 mm in external diameter) were found in the mitral isthmus in 54%, at the LA roof in 54%, and at the LA anterior wall in 29%. Around the left PV ostia, there were areas with major arteries in up to 37% (at the roof and inferior segments) and around the right PV ostia in up to 29% (at the roof segment).
Conclusions:
Major atrial coronary arteries, including the SNA, were commonly found in the areas involved in AF ablation and could cause difficulties in obtaining transmural lesions and electric isolation or even lead to ischemic sinus node or atrial dysfunction.
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