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Concept: Sinus venosus


Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF).

Concepts: Myocardial infarction, Cardiology, Heart failure, Ejection fraction, Heart, Magnetic resonance imaging, Coronary circulation, Sinus venosus


Cardiac hemangiomas represent 1 to 2% of all detected benign heart tumors. Tumors in the coronary sinus have been reported; however, to our knowledge, there have been no reports of masses in a persistent left superior vena cava. We report here the first case of a 58-year-old man with a rare huge unicamerate cardiac hemangiomas in a persistent left superior vena cava. A communication vein between the coronary sinus and hemangiomas could be identified, and thrombus formation was found in the hemangiomas as well.

Concepts: Heart, Report, Artery, Vein, Inferior vena cava, Superior vena cava, Hemangioma, Sinus venosus


BACKGROUND: -To identify and understand clinically encountered pitfalls in the assessment of transmitral conduction block using differential coronary sinus (CS) and left atrial appendage (LAA) pacing techniques in patients with left mitral isthmus (MI) linear ablation. METHODS AND RESULTS: -All the available assessments of MI block were thoroughly reviewed in 271 MI ablation procedures undertaken among 236 patients from October 2008 to April 2011. Bidirectional block was established in 186/271 (69%) procedures. Careful evaluation of electrograms recorded on the multipolar CS and ablation catheters was undertaken to identify and understand the characteristics of pitfall, if any. Pitfall was encountered in 55/271 (20%) procedures among 51 patients and categorized into 6 types (types 1, 3, 4 and 5 led to spurious diagnosis of block; types 2 and 6 led to erroneous diagnosis of absence of block). There were 14, 10, 17, 2, 15 and 3 (total=61) cases of pitfall-types 1 through 6 respectively. Operator recognized 42/61 (69%) pitfalls intraprocedurally. Recognition of types 1 and 5 was difficult due to indiscernible electrograms at usual amplifier-settings or presence of very slow conduction mimicking block. CONCLUSIONS: -Every fifth assessment of bidirectional block across MI linear lesion using differential CS and LAA pacing techniques encounters a pitfall, which can lead to erroneous clinical diagnosis of block or absence of block. Recognition of pitfall during the procedure is feasible and necessitates careful distinction of far-field LA from the local CS electrograms besides appropriate adjustments in catheter position and pacing outputs.

Concepts: Medical terms, Evaluation, Heart, Atrial fibrillation, Assessment, Left atrial appendage occlusion, Left atrial appendage, Sinus venosus


OBJECTIVE: This study aimed to reveal individual variations in Koch’s triangle using NavX and to evaluate the efficacy of the NavX-guided slow pathway ablation. METHODS: A regional geometry around Koch’s triangle was constructed in 42 consecutive patients with atrioventricular nodal reentrant tachycardia (AVNRT), and a bipolar electrogram map was created with 72 ± 30 sampling points during sinus rhythm to identify sites with Haissaguerre’s slow potentials (SPs) and His bundle electrograms (HBEs) to examine the anatomical and electrical variations. Radiofrequency ablation was performed at the most prominent SP recording site. The acute results and long-term outcome were examined in comparison to another 42 consecutive patients who underwent a conventional fluoroscopy-guided slow pathway ablation in the previous months. RESULTS: The size of Koch’s triangle and the coronary sinus ostium varied over a wide range of 132 to 490 and 69 to 346 mm(2), respectively. HBEs were recorded linearly along the antero-septal right atrium (n = 29) or deviated downward toward the midseptum (n = 13, 31 %). The SPs were always distributed below the lowest HBE recording site. The NavX-guided ablation eliminated AVNRT with a median of 1 radiofrequency pulse, 9.1 ± 4.6 min of fluoroscopy, and 49 ± 14 min of procedure time, all of which were significantly smaller than those in fluoroscopy-guided ablation. No procedure-related complications or long-term recurrence was noted in either group. CONCLUSION: Koch’s triangle varies in terms of the size and electrogram distribution, and the NavX-guided slow pathway ablation overcomes the diversity and seems more effective than fluoroscopy-guided ablation.

Concepts: Cardiology, Heart, Atrial fibrillation, Cardiac electrophysiology, Supraventricular tachycardia, Sinus venosus, AV nodal reentrant tachycardia, Coronary sinus


The treatment of atrial tachycardia (AT) occurring after ablation for atrial fibrillation (AF) is challenging. The most common ablation strategy relies on entrainment, and electroanatomic activation mapping (EAM) using a conventional window of interest (WOI), centered on the easily detectable atrial signal on the coronary sinus catheter. We describe a novel EAM annotation technique that uses a WOI starting 40 ms prior to the P wave in order to detect the reentrant AT exit site. This WOI timing is based on the similarity between scar-related reentrant AT and scar-related ventricular tachycardia.

Concepts: Cardiology, Heart, Atrial fibrillation, Ventricular tachycardia, Supraventricular tachycardia, Tachycardia, Sinus venosus, Signal 1


Endocarditis of a prosthetic heart valve is a life-threatening condition that is associated with high morbidity and mortality. Perivalvular extension in infective endocarditis includes complications such as periannular or intramyocardial abscesses, pseudoaneurysms and fistulae. The incidence of perivalvular extension ranges from 10 to 30% in native valve endocarditis and 30 to 55% in prosthetic aortic-valve endocarditis. Herein, we describe a case of a 66-year-old man who presented endocarditis of a prosthetic aortic valve complicated by infective pseudoaneurysm with localization next to the right coronary sinus of Valsalva. Moreover, we underscore the importance of the diagnostic imaging tools options and surgical timing.

Concepts: Heart, Infective endocarditis, Valvular heart disease, Artificial heart valve, Endocarditis, Sinus venosus, Heart valve, Coronary sinus


Respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, provides cardiac risk stratification information. RSA can be quantified from Holter recordings as the high-frequency component of heart rate variability or as the variability of RR intervals in individual respiratory cycles. However, as a risk predictor, RSA is neither exceptionally sensitive nor specific.

Concepts: Blood, Cardiology, Heart, Pulse, Atrium, Acceleration, Thoracic cavity, Sinus venosus


Recent evidence suggests that left atrial (LA) dysfunction may be mechanistically contributing to cerebrovascular events in patients with atrial fibrillation (AF). We investigated the association between regional LA function and a prior history of stroke during sinus rhythm in patients referred for catheter ablation of AF.

Concepts: Heart, Atrial fibrillation, Sociology, The Association, Atrium, Atrial flutter, Social sciences, Sinus venosus


The relationship between mortality and heart rate remains unclear for patients with heart failure with reduced ejection fraction in either sinus rhythm or atrial fibrillation (AF).

Concepts: Myocardial infarction, Cardiology, Heart failure, Ejection fraction, Heart, Atrial fibrillation, Atrium, Sinus venosus


Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied.

Concepts: Patient, Hospital, Cardiology, Heart, Atrial fibrillation, Physician, Atrium, Sinus venosus