From the Cardiovascular Section, Departments of Medicine and Pathology
(J.P.), University of Oklahoma Health Sciences Center and Department of
Veterans Affairs Medical Center, Oklahoma City.
Correspondence to Warren M. Jackman, MD, University of Oklahoma Health Sciences Center, Cardiovascular Section, 920 S.L. Young Blvd (5SP300), Oklahoma City, OK 73104.
Background—The purpose of this
study was to determine whether the coronary sinus (CS)
musculature has electrical connections to the right atrium (RA) and
left atrium (LA) and forms an RA-LA connection.
Methods and Results—Six excised dog hearts were perfused in a
Langendorff preparation. A 20-electrode catheter (2-4-2-mm spacing
center to center) was placed along the CS. Excision of the
pulmonary veins provided access to the LA, and a second
20-electrode catheter was placed along the LA endocardium opposite the
CS catheter. An incision opened the CS longitudinally, and
microelectrodes were inserted into the CS musculature and adjacent LA
myocardium. Continuous CS musculature was visible along a
35±9-mm length of the CS beginning at the ostium. During lateral LA
pacing, CS electrodes recorded double potentials, a rounded,
low-frequency potential followed by a sharp potential. The rounded
initial potential propagated in the lateral-to-septal direction and
represented "far-field" LA activation (timing coincided
with adjacent LA potentials and with action potentials recorded
from microelectrodes in adjacent LA cells). The sharp potential
represented CS activation (timing coincided with action
potentials recorded from CS musculature). A distal LA-CS connection
(earliest sharp potential in the CS during lateral LA pacing) was
located 26±7 mm from the ostium. During RA pacing posterior to
the CS ostium, CS electrodes recorded septal-to-lateral activation
of the high-frequency potential, with slightly later activation of the
rounded potential (LA activation). Incisions surrounding the CS ostium
isolating the ostium from the RA had no effect on the CS musculature
and LA potentials during RA pacing within the isolated segment
containing the CS ostium. RA pacing outside the isolated segment
delayed activation of the CS musculature until after LA activation,
confirming that the RA-CS connection was located in the region of the
CS ostium as well as confirming the presence of the LA-CS
connection.
Conclusions—In canine hearts, the CS musculature is electrically
connected to the RA and the LA and forms an RA-LA connection.
© 1998 American Heart Association, Inc.
Basic Science Reports
Electrical Conduction Between the Right Atrium and the Left Atrium via the Musculature of the Coronary Sinus
Key Words: atrium • conduction • action potentials • arrhythmia
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