{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:09:55Z","timestamp":1761808195176,"version":"3.37.3"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,9,12]],"date-time":"2018-09-12T00:00:00Z","timestamp":1536710400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>It is commonly conceived that coronary sinus (CS) participates in atrial flutter (AFL) circuit but limited to the fibers surrounding its ostium. We evaluated the involvement of proximal CS in typical AFL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty AFL patients underwent entrainment mapping using postpacing interval minus AFL cycle length (PPI\u2010AFL CL) including CS where a decapolar catheter was positioned with proximal bipole 1\u2009cm from the ostium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We compared patients with proximal CS within the circuit (group 1, PPI\u2010AFL CL\u2009\u2264\u200920\u2009ms\u2009+\u2009concealed entrainment) and those without (group 2, PPI\u2010AFL CL\u2009&gt;\u200920\u2009ms). Group 1 patients were older, 77.5\u2009\u00b1\u20094 vs 71\u2009\u00b1\u200912 years (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). No difference was found in AFL CL, PPI\u2010AFL CL at cavotricuspid isthmus (CTI) entry, plateau, and septal site. Group 1 patients had shorter PPI\u2010AFL CL at proximal CS (9\u2009\u00b1\u20093 vs 40\u2009\u00b1\u200915\u2009ms; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and fragmented mesodiastolic CS atrial potentials (APs) (106\u2009\u00b1\u200927 vs 58.5\u2009\u00b1\u200922\u2009ms; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). A mid\u2010septal unexcitable scar was found in five of eight group 1 patients vs one of 12 group 2 patients (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). All were ablated at CTI. A patient had AFL recurrence and underwent a second attempt: PPI\u2010AFL CL was 60\u2009ms at CTI entry and less than or equal to 20\u2009ms at septal CTI and proximal CS; AFL was terminated 1\u2009cm inside CS, applying RF at a fragmented AP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Proximal CS appears to be involved in a substantial subset of typical AFL patients, in whom advanced age, fragmented CS APs, and the presence of right atrial scar are prevalent. Proximal CS might be considered as an un\u2010\u201cinnocent by\u2010stander,\u201d but able, in rare cases, to generate a second AFL circuit.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13703","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T10:26:53Z","timestamp":1533637613000},"page":"1508-1514","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Is proximal coronary sinus involved in the circuit in some cases of ECG \u201ctypical\u201d atrial flutter?"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8882-0449","authenticated-orcid":false,"given":"Antonio","family":"De Sisti","sequence":"first","affiliation":[{"name":"Rhythmology Unit, Cardiology Department Henry Mondor Hospital Aurillac France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius","family":"Andronache","sequence":"additional","affiliation":[{"name":"Rhythmology Unit, Cardiology Department University Hospital Center Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Damiano","sequence":"additional","affiliation":[{"name":"Rhythmology Unit, Cardiology Department Henry Mondor Hospital Aurillac France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman","family":"Eschalier","sequence":"additional","affiliation":[{"name":"Rhythmology Unit, Cardiology Department University Hospital Center Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Font","sequence":"additional","affiliation":[{"name":"Rhythmology Unit, Cardiology Department Henry Mondor Hospital Aurillac 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