![]() In addition, cells similar to those of sinus node (P cells) with increased quantity of merged connective tissue were also found. On the posterior surface of CS, multiple Purkinje like cells with typical features like clear perinuclear halo, are present near the entrance of oblique Marshall veins. ![]() In contrast to veins, the CS contains myocardial tissue, which is a continuation of left atrium muscles, consisting of striated myofibrils like those of myocardium with intercalated discs Jan Evangelista Purkyně was probably the first to discover this important fact. described three discrete layers including endocardium, myocardium, and epicardium similar to those of four cardiac chambers, which makes it different from other cardiac veins. Histological Features of CSīarceló et al. CS ablation can be done in patients with AF with CS anomalies even without prior PVs isolation. reported the relationship between CS ostium enlargement and supraventricular tachycardia in children. These anomalies also affect the electrophysiological characteristics of CS. enlargement of CS, absence of CS, atresia of RA CS ostium, and hypoplasia of the CS. The CS anomalies are classified by Mantini et al. This double muscular covering of the CS plays an important role in interatrial connection. Muscular sheath is a derivative of the left sinus horn with some involvement from developing adjacent LA. The proximal two-thirds of the CS have double muscular covering from the embryonic stage. Some of these muscular sleeve fibers join left atrial (LA) myocardial tissue that makes second most important connection between atria. The muscular tissue around CS can be right atrial (RA) myocardial tissue continuation. The CS and oblique vein of Marshall are both derivatives of sinus venosus. Maturity and sexual dimorphism of the CS during antenatal period have an impact on its histological and electrophysiological features. 1).Įmbryologically, the CS originates from the differentiation of the left sinus horn that is vital for the development of the complete venous system of the heart. Anatomically, CS starts from the ostium in the right atrium, positioned below the foramen ovale and above the inferior vena cava, and ends as a great cardiac vein (Fig. Remaining parts of the heart are drained by small cardiac veins into the ostium of CS. The great cardiac vein joins the main posterior lateral vein to form CS. The anterior wall of the left ventricle and the interventricular septum are drained by the tributaries of the anterior interventricular vein, which collectively form the great cardiac vein on the annulus. The CS is the continuation of the great cardiac vein that runs posteriorly in the left atrioventricular groove (Fig. The CS receives four major tributaries: the great, middle, small, and posterior cardiac veins the other two groups include anterior veins of the right ventricle also called anterior cardiac veins and the smallest group of cardiac veins named Thebesian veins that drain directly into the tributaries of the greater and smaller cardiac veins. About 60% of drainage is performed by CS, the remaining 40% by anterior and small cardiac veins. ![]() The CS has a key role in myocardial venous drainage. This review will also inform readers about application of CS in other electrophysiological procedures. This review will provide updated knowledge on developmental, histological, and macroscopic anatomical aspects of CS with its role as arrhythmogenic substrate. The purpose of our review is to summarize updates and to clarify the role of coronary sinus (CS) in AF induction and propagation. ![]() According to many studies, PVI alone is not enough to deal with persistent AF. Over the last few decades, we have been trying to gain insight into AF mechanisms, and have come to the conclusion that there must be some triggers and substrates other than pulmonary veins. The recurrence rate of AF in patients with persistent AF is very high, which shows the inadequacy of pulmonary vein isolation (PVI). But the most challenging type is still persistent AF. During the last few decades, owing to numerous advancements in the field of electrophysiology, we reached satisfactory outcomes for paroxysmal AF with the help of ablation procedures. Atrial fibrillation (AF) is the most frequent atrial arrhythmia. ![]()
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