Left atrial branches of coronary arteries; clinical implications related to linear catheter ablation for atrial fibrillation

• Published in: Journal of interventional cardiac electrophysiology Vol. 25; no. 2; pp. 141 - 144
• Main Authors: Yano, Akio, Igawa, Osamu, Adachi, Masamitsu, Miake, Junichiro, Inoue, Yoshiaki, Ogura, Kazuyoshi, Kato, Masaru, Iitsuka, Kazuhiko, Hisatome, Ichiro
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-08-2009; Springer Nature B.V
• Subjects: Aged; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - methods; Coronary Angiography; Coronary Vessels - surgery; Female; Heart Atria - diagnostic imaging; Heart Atria - surgery; Humans; Male; Medicine; Medicine & Public Health; Recurrence; Complication; Catheter ablation; Atrial fibrillation; Coronary artery
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-008-9352-9

Background
Coronary artery damage has been reported during catheter ablation procedures. Recently, linear ablation of thin left atrial tissue has been performed for atrial fibrillation.
Objective and Methods
Because we have little information about the arteries in the left atrium, this study was performed to evaluate the anatomy of these arteries, and to compare them with previously reported ablation lines. Coronary angiography was performed in 262 patients. Atrial coronary arteries between the left atrial appendage and the left superior pulmonary vein (LAA-LSPV region), as well as between the left inferior pulmonary vein and the mitral annulus (“mitral isthmus” region) were examined.
Results
Atrial coronary arteries extending to the LAA-LSPV region were found in 92 subjects (35%), while arteries crossing the mitral isthmus region were found in 119 subjects (46%). Atrial coronary arteries crossed the ablation line in about 69% of subjects overall.
Conclusion
These results might suggest a risk of acute complications due to left atrial ablation. Alternatively, recurrence of atrial fibrillation might be caused by protected myocardium around the atrial arteries. We should note that atrial coronary arteries cross the ablation line in many patients.