Case Studies

Arrhythmia Grand Rounds, June 2015, Volume 1, Issue 2: 58-59
DOI: 10.12945/j.aorta.2015.002-15

Apparent Double Activation of Coronary Sinus in Sinus Rhythm

Ashok J Shah, Patrizio Pascale, Andrei Forclaz, Laurent Roten, Xingpeng Liu, Shinsuke Miyazaki, Meleze Hocini

Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France


Disparate activation of the coronary sinus and inferior left atrium is known to occur during atrial tachycardia arising from persistent atrial fibrillation ablation. The image below shows the persistence of disparity in sinus rhythm which looks like doubly activated coronary sinus.

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Benjamin Scherlag — Oct 13, 2015 4:02 PM
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To the Authors: I would call the authors attention to an early study (Scherlag et al. Inferior Interatriial pathway in the dog. Circulation Research.1972;31:18-35) in which double potentials were found from the coronary sinus ostium to the end of the ligament of Marshall representing an inferior right to left atrial connection .“The compound nature of the potentials recorded from the coronary sinus and the inferior left atrium just above the AV groove were frequently observed, as well as the fractionation of these compound potentials into slow and fast components during several physiological interventions (Figure 3-5).[fast pacing rates from vaious atrial sites]” this inferior ineratrial pathway is a counterpart to the superior ineratrial connection, i.e., Bachman's bundle. Both pathways have been shown to contain slow and fast conducting atrial myocardium (Wagner et al. Specialized conducting fibers in the interatrial band. Circ Res 1966:18:502-518). It can be surmised that the extensive biatrial ablations in the present study provided the basis for vulnerability to show block between the double potentials recorded in the coronary sinus, particularly at shorter cycle lengths. BJ Scherlag, PhD Heart Rhythm Institute Oklahoma University Health Sciences Center Oklahoma City, OK