Coronary sinus cannulation predicts atrioventricular nodal reentry as mechanism of supraventricular tachycardia

Tiago Luiz Luz Leiria; Mauricio Branchi; Roberto Tofani Sant'anna; Eduardo Dytz Almeida; Leonardo Martins Pires; Marcelo Lapa Kruse; Vidal Essebag; Marco Aurélio Lumertz Saffi; Gustavo Glotz de Lima

doi:10.1016/j.ipej.2019.04.006

Coronary sinus cannulation predicts atrioventricular nodal reentry as mechanism of supraventricular tachycardia

Indian Pacing Electrophysiol J. 2019 Sep-Oct;19(5):178-182. doi: 10.1016/j.ipej.2019.04.006. Epub 2019 Apr 26.

Authors

Tiago Luiz Luz Leiria¹, Mauricio Branchi², Roberto Tofani Sant'anna², Eduardo Dytz Almeida², Leonardo Martins Pires², Marcelo Lapa Kruse², Vidal Essebag³, Marco Aurélio Lumertz Saffi⁴, Gustavo Glotz de Lima²

Affiliations

¹ Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: drleiria@gmail.com.
² Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.
³ Electrophysiology Department of McGill University Health Centre - Director of Cardiac Electrophysiology, McGill University Health Centre, Canada.
⁴ Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Abstract

Introduction: Common clinical teaching, for invasive electrophysiology, is that if the first year fellow cannulates the coronary sinus (CS) in his first attempt, the arrhythmia is more likely to be atrioventricular nodal reentry tachycardia (AVNRT). This general perception has not yet been clinically tested. We evaluated this theory in prospective patients undergoing an electrophysiological study (EPS) for paroxysmal supraventricular tachycardia (PSVT).

Methods: Cohort study. CS ease of cannulation (CSCS) was graded as: 1) 1st year fellow cannulates in first attempt; 2) 1st year fellow needs more than one attempt or maneuver to cannulate the CS; 3) staff physician cannulates in first attempt after the fellow was unsuccessful; 4) staff physician requires more than one maneuver to cannulate the CS; 5) staff physician judges that the cannulation process was extremely difficult.

Results: Of the 1361 patients undergoing EPS in our institution, 165 were selected. Age was 49 ± 15 years. AVNRT occurred in 77.6%, atrioventricular reentry tachycardia (AVRT) in 15.1% and atrial tachycardia (AT) in 7.3% of cases. The CSCS = 1 was more prevalent in AVNRT, 89% versus 68% AVRT and 58.3% of AT (P = 0.0005). Patients with CSCS = 1 have a higher chance of the PSVT being AVNRT (odds ratio: 4.41; 95CI: 1.84-10.56; P = 0.0009).

Conclusion: The CSCS predicts the likelihood of the induced PSVT being AVNRT as compared to AVRT and AT. More studies are required to try to associate this finding to clinical patient characteristics to create a score for PSVT mechanism prediction.

Keywords: Atrioventricular nodal reentry; Catheter ablation; Coronary sinus; Tachycardia.