Role of the Coronary Sinus in Maintenance of Atrial Fibrillation

Hakan Oral*, Mehmet Ozaydin, Aman Chugh, Christoph Scharf, Hiroshi Tada, Burr Hall, Peter Cheung, Frank Pelosi, Bradley P. Knight, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Introduction: Bursts of tachycardia arising in the pulmonary veins may play an important role in perpetuating atrial fibrillation (AF). However, the role of the coronary sinus (CS) in the perpetuation of AF has been unclear. The aim of this study was to determine whether the CS plays a role in perpetuation of AF. Methods and Results: Pulmonary vein isolation was performed by segmental ostial ablation with radiofrequency energy in 22 consecutive patients with paroxysmal AF. Bipolar and unipolar electrograms recorded in the left atrium and CS were analyzed during atrial pacing from the mitral annulus and during AF. There was a mean of 2.5 ± 0.5 electrical connections between the CS and the left atrium. The electrical connections between the left atrium and CS were ablated with a mean of 6.2 ± 2.7 minutes of radiofrequency energy applied along the atrial side of the inferior mitral annulus. During AF, episodes of intermittent tachycardia alternated between the left atrium and the CS. Among the 22 patients, sustained AF was still inducible in 9 after pulmonary vein isolation. After electrical disconnection of the CS from the left atrium, sustained AF was inducible in only 3 of these 9 patients. Conclusion: The CS may be a source of rapid repetitive electrical activity during AF. The lower probability of inducible sustained AF after electrical disconnection of the CS from the left atrium suggests that the CS may play a role in perpetuating AF.

Original languageEnglish (US)
Pages (from-to)1329-1336
Number of pages8
JournalJournal of cardiovascular electrophysiology
Issue number12
StatePublished - Dec 2003


  • Atrial fibrillation
  • Catheter ablation
  • Coronary sinus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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