Arrhythmias & electrophysiology
Characteristics of Localized Re-Entrant Atrial Tachycardia Involving the Coronary Sinus in the Tachycardia Circuit
Authors' conclusion
CS-ATs are a rare cause of AT, typically occurring after ablation in the inferior part of the LA or CS. Diagnosing CS-ATs can be challenging. Ablation targeting the LA-CS connection is effective, and ethanol infusion into the vein of Marshall is a viable therapeutic option.
Study context
- Population
- Consecutive patients with atrial tachycardias (ATs) mapped by a high-density mapping system
- Participants
- 545 patients775 ATs
- Outcome
- Prevalence, clinical characteristics and electrophysiological properties of CS-ATs
Methodological detailsconsecutive patients, high-density mapping
- Consecutive patients
- High-density mapping
Main finding
As reported in the abstract
Prevalence of CS-ATs
CS-ATs, % of all ATs
1.0%
8 CS-ATs; 95% CI: 0.5%–2.0%
Patients with CS-AT, % of all patients
1.5%
8 patients; 95% CI: 0.7%–2.9%
Observational data: associations, not effects.
Further findings
Prior ablation and scar
- Scar in inferior septum or bottom wall (6 patients)
- 75%
- All had prior ablation in inferior septum, left atrium (LA) bottom wall or coronary sinus (CS)
Electrophysiological properties
- Mean tachycardia cycle length (milliseconds)
- 299 ± 70
- CS segment length in circuit (mm)
- 28 ± 11
- CS segment conduction time (milliseconds)
- 58 ± 31
- CS conduction time, % of tachycardia cycle length
- 21% ± 13%
- All CS-ATs: centrifugal activation from inferior LA
Diagnosis and ablation outcome
- Correctly diagnosed (patients)
- 2
- Terminated by ablation targeting LA-CS connection (patients)
- 4
- Ethanol infusion into vein of Marshall required (patients)
- 3
- Not terminated, inappropriate ablation strategy (patients)
- 1
Original publication
Characteristics of Localized Re-Entrant Atrial Tachycardia Involving the Coronary Sinus in the Tachycardia Circuit. JACC Clin Electrophysiol. Published 24 September 2025. doi:10.
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