Intra-Atrial Right Coronary Artery and its Ablation Implications

Balaji Krishnan, Caroline Cross, Richard Dykoski, David G. Benditt, Mackenzie Mbai, Edward McFalls, Jian Ming Li, Stefan Bertog, Venkatakrishna N. Tholakanahalli

Research output: Contribution to journalArticle

Abstract

Objectives The study examined the frequency in which a right coronary artery (RCA) anomaly resulting in intra-atrialization of the vessel might increase risk of RCA damage during routine radiofrequency ablation in the right atrium even with low power or temperature. Background Right coronary artery (RCA) injury with endocardial RF ablation of the right atrium is a rare complication. Methods This prospective observational study comprised an analysis of coronary artery anatomies in 331 patients who underwent autopsies at our institution from 2005 to 2014. The presence of intra-atrial RCA including the number and length of intra-atrial RCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Results The authors report a case series of 6 of 331 (1.8%) patients in whom autopsies showed evidence of an intra-atrial RCA. The patients were all men (average 69 ± 12 years of age). They observed 3 variations of the intra-atrial RCA course. In 2 similar variations, the RCA entered the anterolateral aspect of the right atrium, returning to its normal distribution to supply the distal RCA (case 4 of 6) and the atrioventricular nodal artery (case 1 of 6). In the sixth case, the atrialized artery was an anterior branch of the RCA, in which the artery similarly coursed across the pectinate muscles, extending to the region of the anterior crista terminalis, before diving into the muscle. Conclusions The prevalence and variants of the intra-atrial RCA have not been reported before. In the presence of an intra-atrial artery, RCA damage may occur due to direct injury rather than collateral injury due to transmural extension of an ablation lesion.

Original languageEnglish (US)
Pages (from-to)1037-1045
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume3
Issue number9
DOIs
StatePublished - Sep 1 2017

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Coronary Vessels
Arteries
Heart Atria
Autopsy
Wounds and Injuries
Muscles
Diving
Normal Distribution
Observational Studies
Coronary Artery Disease
Anatomy
Prospective Studies
Temperature

Keywords

  • anatomy
  • anomalies
  • coronary artery injury
  • right coronary artery

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Intra-Atrial Right Coronary Artery and its Ablation Implications. / Krishnan, Balaji; Cross, Caroline; Dykoski, Richard; Benditt, David G.; Mbai, Mackenzie; McFalls, Edward; Li, Jian Ming; Bertog, Stefan; Tholakanahalli, Venkatakrishna N.

In: JACC: Clinical Electrophysiology, Vol. 3, No. 9, 01.09.2017, p. 1037-1045.

Research output: Contribution to journalArticle

Krishnan, Balaji ; Cross, Caroline ; Dykoski, Richard ; Benditt, David G. ; Mbai, Mackenzie ; McFalls, Edward ; Li, Jian Ming ; Bertog, Stefan ; Tholakanahalli, Venkatakrishna N. / Intra-Atrial Right Coronary Artery and its Ablation Implications. In: JACC: Clinical Electrophysiology. 2017 ; Vol. 3, No. 9. pp. 1037-1045.
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abstract = "Objectives The study examined the frequency in which a right coronary artery (RCA) anomaly resulting in intra-atrialization of the vessel might increase risk of RCA damage during routine radiofrequency ablation in the right atrium even with low power or temperature. Background Right coronary artery (RCA) injury with endocardial RF ablation of the right atrium is a rare complication. Methods This prospective observational study comprised an analysis of coronary artery anatomies in 331 patients who underwent autopsies at our institution from 2005 to 2014. The presence of intra-atrial RCA including the number and length of intra-atrial RCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Results The authors report a case series of 6 of 331 (1.8{\%}) patients in whom autopsies showed evidence of an intra-atrial RCA. The patients were all men (average 69 ± 12 years of age). They observed 3 variations of the intra-atrial RCA course. In 2 similar variations, the RCA entered the anterolateral aspect of the right atrium, returning to its normal distribution to supply the distal RCA (case 4 of 6) and the atrioventricular nodal artery (case 1 of 6). In the sixth case, the atrialized artery was an anterior branch of the RCA, in which the artery similarly coursed across the pectinate muscles, extending to the region of the anterior crista terminalis, before diving into the muscle. Conclusions The prevalence and variants of the intra-atrial RCA have not been reported before. In the presence of an intra-atrial artery, RCA damage may occur due to direct injury rather than collateral injury due to transmural extension of an ablation lesion.",
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AU - Tholakanahalli, Venkatakrishna N.

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N2 - Objectives The study examined the frequency in which a right coronary artery (RCA) anomaly resulting in intra-atrialization of the vessel might increase risk of RCA damage during routine radiofrequency ablation in the right atrium even with low power or temperature. Background Right coronary artery (RCA) injury with endocardial RF ablation of the right atrium is a rare complication. Methods This prospective observational study comprised an analysis of coronary artery anatomies in 331 patients who underwent autopsies at our institution from 2005 to 2014. The presence of intra-atrial RCA including the number and length of intra-atrial RCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Results The authors report a case series of 6 of 331 (1.8%) patients in whom autopsies showed evidence of an intra-atrial RCA. The patients were all men (average 69 ± 12 years of age). They observed 3 variations of the intra-atrial RCA course. In 2 similar variations, the RCA entered the anterolateral aspect of the right atrium, returning to its normal distribution to supply the distal RCA (case 4 of 6) and the atrioventricular nodal artery (case 1 of 6). In the sixth case, the atrialized artery was an anterior branch of the RCA, in which the artery similarly coursed across the pectinate muscles, extending to the region of the anterior crista terminalis, before diving into the muscle. Conclusions The prevalence and variants of the intra-atrial RCA have not been reported before. In the presence of an intra-atrial artery, RCA damage may occur due to direct injury rather than collateral injury due to transmural extension of an ablation lesion.

AB - Objectives The study examined the frequency in which a right coronary artery (RCA) anomaly resulting in intra-atrialization of the vessel might increase risk of RCA damage during routine radiofrequency ablation in the right atrium even with low power or temperature. Background Right coronary artery (RCA) injury with endocardial RF ablation of the right atrium is a rare complication. Methods This prospective observational study comprised an analysis of coronary artery anatomies in 331 patients who underwent autopsies at our institution from 2005 to 2014. The presence of intra-atrial RCA including the number and length of intra-atrial RCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Results The authors report a case series of 6 of 331 (1.8%) patients in whom autopsies showed evidence of an intra-atrial RCA. The patients were all men (average 69 ± 12 years of age). They observed 3 variations of the intra-atrial RCA course. In 2 similar variations, the RCA entered the anterolateral aspect of the right atrium, returning to its normal distribution to supply the distal RCA (case 4 of 6) and the atrioventricular nodal artery (case 1 of 6). In the sixth case, the atrialized artery was an anterior branch of the RCA, in which the artery similarly coursed across the pectinate muscles, extending to the region of the anterior crista terminalis, before diving into the muscle. Conclusions The prevalence and variants of the intra-atrial RCA have not been reported before. In the presence of an intra-atrial artery, RCA damage may occur due to direct injury rather than collateral injury due to transmural extension of an ablation lesion.

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