1. Circ Arrhythm Electrophysiol
Local Coronary Flow Is Associated With an Unsuccessful Complete Block Line at the Mitral Isthmus in Patients With Atrial FibrillationClinical Perspective
by Toshiya Kurotobi, Yoshihisa Shimada, Naoto Kino, Katsuomi Iwakura, Koichi Inoue, Ryusuke Kimura, Yuko Tosyoshima, Hiroya Mizuno, Yuji Okuyama, Kenshi Fujii, Shinsuke Nanto, and Issei Komuro
Circ Arrhythm Electrophysiol
Volume 4(6):
December 20, 2011
Copyright © American Heart Association, Inc. All rights reserved.

2. Representative cases with (A, right anterior oblique view; B, left anterior oblique view) and without (C, right anterior oblique view; D, left anterior oblique view) a local coronary artery (LCA) across the mitral isthmus (MI) area.
Representative cases with (A, right anterior oblique view; B, left anterior oblique view) and without (C, right anterior oblique view; D, left anterior oblique view) a local coronary artery (LCA) across the mitral isthmus (MI) area. A catheter with multiple electrodes was located along the coronary sinus (CS). In the cases with an LCA, a large left circumflex artery (LCX) (arrow) is running across the MI area above the CS (A and B). However, a small LCX travels vertically down in the ventricular direction through the base of the left atrial appendage in the cases without an LCA at the MI.
Toshiya Kurotobi et al. Circ Arrhythm Electrophysiol. 2011;4:
Copyright © American Heart Association, Inc. All rights reserved.

3. Representative cases with a local coronary artery (LCA) originating from the left circumflex artery (LCX; A) and right coronary artery (B).
Representative cases with a local coronary artery (LCA) originating from the left circumflex artery (LCX; A) and right coronary artery (B). A small branch of the sinus nodal artery from the LCX (arrow) runs across the mitral isthmus (MI; A), and a branch of the number 4 AV branch from the dominant right coronary artery (arrow) extends to the MI area (B).
Toshiya Kurotobi et al. Circ Arrhythm Electrophysiol. 2011;4:
Copyright © American Heart Association, Inc. All rights reserved.

4. Coronary angiography (A) and subsequent staining with contrast medium of the coronary sinus (CS; B) in the 45° left anterior oblique projection; the mean diameter of the local coronary artery (LCA) and CS across the mitral isthmus (MI) was measured at this angle.
Coronary angiography (A) and subsequent staining with contrast medium of the coronary sinus (CS; B) in the 45° left anterior oblique projection; the mean diameter of the local coronary artery (LCA) and CS across the mitral isthmus (MI) was measured at this angle.
Toshiya Kurotobi et al. Circ Arrhythm Electrophysiol. 2011;4:
Copyright © American Heart Association, Inc. All rights reserved.

5. The schema of the intracardiac local electrograms at the mitral isthmus (MI) line.
The schema of the intracardiac local electrograms at the mitral isthmus (MI) line. The local potential at the MI was assessed using a 20-pole diagnostic catheter with a 2-mm interelectrode spacing located in the coronary sinus (CS). We measured the atrial (A) wave amplitude (positive deflection, negative deflection, and positive/negative ratio) and ventricular (V) wave amplitude as an index of the circumstance of the local atrial properties at the MI.
Toshiya Kurotobi et al. Circ Arrhythm Electrophysiol. 2011;4:
Copyright © American Heart Association, Inc. All rights reserved.

6. A comparison of the creation of a successful mitral isthmus (MI) block line between the patients with and without a local coronary artery (LCA).
A comparison of the creation of a successful mitral isthmus (MI) block line between the patients with and without a local coronary artery (LCA). The ratio of a successful MI block line was significantly lower in the patients with an LCA than in those without an LCA (42% versus 92%; P<0.001).
Toshiya Kurotobi et al. Circ Arrhythm Electrophysiol. 2011;4:
Copyright © American Heart Association, Inc. All rights reserved.