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. 2022 Jan 21:12:790077.
doi: 10.3389/fphys.2021.790077. eCollection 2021.

Association Between the Coronary Sinus Ostial Size and Atrioventricular Nodal Reentrant Tachycardia in Patients With Pulmonary Arterial Hypertension

Lei Ding  1 , Sixian Weng  1 , Zhengqin Zhai  1 , Bin Zhou  2 , Yingjie Qi  1 , Fengyuan Yu  1 , Hongda Zhang  1 , Shu Zhang  1 , Min Tang  1
Affiliations

Association Between the Coronary Sinus Ostial Size and Atrioventricular Nodal Reentrant Tachycardia in Patients With Pulmonary Arterial Hypertension

Lei Ding et al. Front Physiol. .

Abstract

Aims: The incidence of atrioventricular nodal reentrant tachycardia (AVNRT) is higher in pulmonary arterial hypertension (PAH) patients than in the general population. AVNRT is reportedly associated with a larger coronary sinus (CS) ostium (CSo). However, the correlation between AVNRT and CSo size in PAH patients is poorly investigated. We aimed to investigate the impact of CSo size on AVNRT and identify its risk factors in PAH.

Methods and results: Of 102 PAH patients with catheter ablation of supraventricular tachycardia (SVT), twelve with a confirmed AVNRT diagnosis who underwent computed tomographic angiography were retrospectively enrolled as the study group. The control group (PAH without SVT, n = 24) was matched for sex and BMI at a 2:1 ratio. All baseline and imaging data were collected. Mean pulmonary artery pressure was not significantly different between the two groups (65.3 ± 16.8 vs. 64.5 ± 17.6 mmHg, P = 0.328). PAH patients with AVNRT were older (45.9 ± 14.8 vs. 32.1 ± 7.6 years, P = 0.025), had a larger right atrial volume (224.4 ± 129.6 vs. 165.3 ± 71.7 cm3, P = 0.044), larger CSo in the left anterior oblique (LAO) plane (18.6 ± 3.3 vs. 14.8 ± 4.0 mm, P = 0.011), and larger CSo surface area (2.08 ± 1.35 vs. 1.45 ± 0.73 cm2, P = 0.039) and were more likely to have a windsock-shape CS (75% vs. 16.7%, P = 0.001) than those without AVNRT. A linear correlation was shown between CSo diameter in the LAO-plane and the atrial fractionation of the ablation target for AVNRT (R 2 = 0.622, P = 0.012).

Conclusion: Anatomical dilation of the CSo is a risk factor for AVNRT development in patients with PAH.

Keywords: atrioventricular nodal reentrant tachycardia; coronary sinus ostium; pulmonary arterial hypertension; radiofrequency ablation; risk factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Measurements of the CS ostium in the axial plane (A) and LAO plane (B) by computed tomographic angiography. CS, coronary sinus; CSo, coronary sinus ostium; LA, left atrium; LAO, left anterior oblique; LV, left ventricle; MCV, middle cardiac vein; RA, right atrium; RV, right ventricle.
FIGURE 2
FIGURE 2
(A) Correlation between the RA volume and CS diameter of the LAO and axial plane (n = 36); (B) Correlation between the LA volume and CS diameter of the LAO and axial planes (n = 36). CSo, coronary sinus ostium; LA, left atrium; LAO, left anterior oblique; RA, right atrium.
FIGURE 3
FIGURE 3
A patient with PAH and AVNRT showed marked vertical dilation of the CSo. (A,B) Measurements in the axial and LAO planes by CTA. (C) Three-dimensional image and panoramic view of the CSo. (D) Fluoroscopy of the ablation target. (E) Intracardiac electrogram of the ablation target (red box) during sinus rhythm. ABL, ablation catheter; AVNRT, atrioventricular nodal reentrant tachycardia; CTA, computed tomographic angiography; CS, coronary sinus; CS-d to CS-p: from distal-to-proximal pair of coronary sinus electrode; CSo, coronary sinus ostium; His, His bundle catheter; LAO, left anterior oblique; LV, left ventricle; PAH, pulmonary arterial hypertension; RA, right atrium; RAO, right anterior oblique; RV, right ventricle; SVC, superior vena cava; TA, tricuspid annulus.
FIGURE 4
FIGURE 4
(A) A patient with PAH and AVNRT showing a windsock-shaped CS; (B) A patient with PAH showing a tubular shape; (C) Comparison of the CS morphology between the two groups. AVNRT, atrioventricular nodal reentrant tachycardia; CS, coronary sinus; CSo, coronary sinus ostium; LAO, left anterior oblique; PAH, pulmonary arterial hypertension; RA, right atrium. The solid yellow line represents the outlines of the CS; the solid yellow arrow indicates the direction of the CS.
FIGURE 5
FIGURE 5
(A) Correlation between the TCL (n = 11) and CS diameter in the LAO and axial planes; (B) Correlation between the AH interval during sinus rhythm (n = 9) and CS diameter in the LAO and axial planes; (C) Correlation between the atrial fractionation at the ablation site (n = 9) and CS diameter in the LAO and axial planes. AH interval, atrial-His interval; CSo, coronary sinus ostium; LAO, left anterior oblique; TCL, tachycardia cycle length.
FIGURE 6
FIGURE 6
Difference in the CSo diameter in PAH patients with and without AVNRT according to multivariate logistic regression. Left panel: axial diameter of the CSo in PAH patients with AVNRT (Pt1) and without AVNRT (Pt2); middle panel: schemes of the triangle of Koch with a normal (solid line) and an enlarged CSo (dashed line); right panel: vertical diameter of the CSo in PAH patients with AVNRT (Pt1) was larger than that in patients without AVNRT (Pt2). AVN, atrioventricular node; AVNRT, atrioventricular nodal reentrant tachycardia; ER, Eustachian ridge; HB, His bundle; TA, tricuspid annulus; ToT, tendon of Todaro; CSo, coronary sinus ostium; LV, left ventricle; PAH, pulmonary arterial hypertension; Pt, patient; RA, right atrium; RAO, right anterior oblique; RV, right ventricle.
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