Overview
Congenital abnormalities of cardiac connection, specifically dual muscular coronary sinus (CS) to left atrial (LA) connections, can be associated with atrial fibrillation (AF) induction 1. These connections, when combined with rate-dependent unidirectional block, may predispose individuals to AF 1.Diagnosis
Identification of dual CS to LA connections may be achieved during electrophysiological studies 1.
A key diagnostic finding is the presence of earliest left atrial activation during distal CS pacing 1.Management
For patients undergoing AF ablation, elimination of distal CS to LA connections may reduce arrhythmia recurrence 1.
The procedure involves targeting earliest LA activation during distal CS pacing, confirmed by changes in local CS atrial electrograms and LA activation sequences 1.Key Recommendations
Elimination of distal coronary sinus (CS) to left atrial (LA) connections may reduce atrial arrhythmia recurrence in patients undergoing AF ablation 1. (Evidence: Strong)
In patients with AF, identify and ablate dual muscular CS to LA connections if associated with earliest LA activation during distal CS pacing 1. (Evidence: Moderate)References
1 Kuo L, Frankel DS, Lin A, Arkles J, Hyman M, Santangeli P et al.. PRECAF Randomized Controlled Trial. Circulation. Arrhythmia and electrophysiology 2021. link