High incidence of acute sub-clinical circumflex artery 'injury' following mitral isthmus ablation
Kelvin C K Wong1, Chris Lim, Praveen P Sadarmin
1Oxford Heart Centre, John Radcliffe Hospital NHS Trust, Oxford OX3 9DU, UK.
European Heart Journal
|May 3, 2011
Summary
Mitral isthmus ablation for atrial fibrillation can cause injury to the circumflex artery, especially when using coronary sinus ablation. Shorter distances and longer ablation times increase this risk.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Mitral isthmus (MI) ablation is a complex procedure for treating atrial fibrillation.
- The circumflex artery is anatomically close to the ablation target, posing a risk of injury during radiofrequency ablation.
Purpose of the Study:
- To evaluate the incidence and risk factors of acute, sub-clinical injury to the circumflex artery following MI ablation.
Main Methods:
- Fifty-four patients undergoing MI ablation for atrial fibrillation were studied.
- Coronary angiography was performed pre- and post-ablation.
- Quantitative coronary angiography analyzed changes, focusing on the circumflex artery and its branches.
Main Results:
- 89% of patients achieved mitral isthmus block; 60% required coronary sinus (CS) ablation.
- 28% of patients showed angiographic changes in the circumflex artery post-ablation.
- CS ablation, longer CS ablation times, shorter circumflex-CS distance, and smaller distal circumflex diameter were associated with circumflex artery injury.
Conclusions:
- Acute, sub-clinical circumflex artery injury is a potential complication of MI ablation.
- Coronary sinus ablation and anatomical proximity are significant risk factors for this injury.
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