Background: Circumferential pulmonary vein isolation is an established therapy for selected patients with atrial fibrillation (AF). Three-dimensional imaging modalities can be useful to establish the mechanism of a procedure-related complication.
Purpose: The purpose of this study was to investigate the course of the sinus node artery (SNA) and the coronary arterial injury during catheter ablation of AF.
Methods: In the 254 consecutive patients, the courses of the SNA were recorded using multislice computed tomography.
Results: The visualization rate was 96.9% (246/254). Of 246 patients, 287 SNAs were detected among which 114 (44.9%) originated from the right coronary artery, 91 (35.9%) from the left circumflex (Cx) artery, and 41 (16.1%) from both the right and Cx artery. Only SNAs originated from the Cx artery coursed along the left atrium. Only in 2 patients, SNAs coursed endocardial surface of the left atrium. In one of these 2 patients, sinus node dysfunction developed just after the ablation of the right superior pulmonary vein ostium, requiring a permanent pacemaker implantation. The SNA originated from the distal Cx artery, and precisely coursed endocardial surface at the radiofrequency application site. Coronary angiography revealed the occlusion of the SNA at that site, and the SNA occlusion was presumed the cause of the sinus node dysfunction in this patient.
Conclusion: The recognition of the course of the SNA is important in minimizing the risk of sinus node dysfunction during catheter ablation of AF.