Location of sinoatrial artery and atria

Background Clinically manifested injury to the coronary arteries during catheter ablation procedures for atrial arrhythmias is rare. Injury to sinoatrial artery can cause sinus arrest and lead to permanent pacemaker implantation. Previous studies only described the anatomy of the artery but not the relation with atrium. Objective Our study aims to illustrate the course of the sinoatrial artery in relation to the atrium. Methods The images of coronary computed tomography angiography (CCTA) of 110 patients performed from June to September 2019 were reviewed. Results The sinus node was supplied by either single artery (98.18%) or dual blood supply (1.82%). Sinoatrial artery mostly originates from right coronary artery (56.25%), followed by left circumflex artery (42.85) and the aorta (0.90%). When sinoatrial artery originated from right coronary artery or the aorta, it ran medially to the right atrium which its course vertically lied within 0.35±0.51 cm above and 1.45±0.63 cm below the superior vena cava-right atrium junction. The artery then passed between left atrium and right atrium, which 21.88% of the course ran within 0.5 cm from the right upper pulmonary vein ostium. When sinoatrial artery arises from left circumflex artery, 95.83% of this pathing were anterior to left atrial appendage. Only 4.17% went along anteriorly to the left upper pulmonary vein. Most of sinoatrial artery that arises from left circumflex artery (97.92%) ran pass the upper one-third of left atrium, then ran toward posteroseptum of right atrium. This course vertically lied within 0.51±0.73 cm above and 0.67±0.83 cm below the superior vena cava-right atrium junction. Additionally, we found that 39.58% of sinoatrial artery arises from left circumflex artery course lied within 0.5 cm from right upper pulmonary vein ostium. Conclusion Exceeding precaution while performing radiofrequency ablation at anterior upper one-third left atrium, base of left atrium appendage, upper part septal wall of right atrium and right upper pulmonary vein ostium should be established to prevent sinoatrial artery injury. FUNDunding Acknowledgement Type of funding sources: None.

SEVEN TYPES OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA IN ONE PATIENT

The report describes the case of electrophysiological study and catheter ablation of seven types of supraventricular tachycardia in one patient. During radiofrequency ablation for WPW-syndrome three functionated discrete retrograde conductive accessory atrioventricular pathways were documented and were successfully ablated. Further incessant activity of two ectopic atrial focuses was revealed. First localized in upper part of crista terminalis and another – in left superior pulmonary vein ostium. Five months after patient had a recurrence of supraventricular tachycardia. EPI-study demonstrated evidence for retrograde ventriculoatrial dissociation with induction of atypical fast/slow and typical slow/fast atrioventricular nodal reentry tachycardia, wich were successfully ablated. With further observation, rhythm disturbances did not recur.