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Related Experiment Video

Updated: Jun 9, 2025

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Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial.

Jonathan P Ariyaratnam1, Melissa E Middeldorp2, Anthony G Brooks3

  • 1Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: https://twitter.com/JonathanAriya.

JACC. Clinical Electrophysiology
|October 22, 2024
PubMed
Summary

Coronary sinus isolation (CSI) did not improve atrial arrhythmia-free survival compared to pulmonary vein isolation (PVI) and roofline ablation alone for high-burden atrial fibrillation (AF). This adjunctive strategy showed no significant benefit in long-term outcomes.

Keywords:
ablationatrial fibrillationcoronary sinusoutcomesrandomized

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • The coronary sinus is implicated in initiating and sustaining atrial fibrillation (AF).
  • Coronary sinus ablation can prolong AF cycle length and terminate AF, particularly in patients with persistent AF post-pulmonary vein isolation (PVI).

Purpose of the Study:

  • To evaluate the efficacy of coronary sinus isolation (CSI) as an add-on ablation strategy for high-burden AF.
  • To conduct a randomized controlled trial comparing CSI plus PVI/roofline versus PVI/roofline alone.

Main Methods:

  • 100 patients with high-burden AF were randomized to PVI, roofline, and CSI, or PVI and roofline only.
  • The primary outcome was 2-year drug-free atrial arrhythmia-free survival after a single procedure.
  • Follow-up included clinical assessment and 7-day Holter monitoring.

Main Results:

  • No significant difference in 2-year single-procedure drug-free survival between the CSI group (62.5%) and the non-CSI group (63.4%).
  • No difference in multiple-procedure drug-assisted survival at 5 years.
  • Complication rates were similar between the groups.

Conclusions:

  • Adjunctive coronary sinus isolation (CSI) does not provide additional benefit over PVI and roofline ablation for de novo treatment of high-burden AF.
  • CSI is not superior to standard PVI and roofline ablation in achieving long-term arrhythmia freedom.