14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-147

Atrial fibrillation: pharmacological cardioversion via the coronary sinus. Experimental investigation forecasting an implantable device

Leonardo Cammilli, Avio Maria Perna, Federico Perna, Gino Grassi, Francesco Cammilli, Giuseppe Vergara*, Francesco Furlanello**.
Experimental Cardiology, Careggi Hospital, Firenze, *Cardiological Dept, Rovereto, **Cardiological and Arrhythmological Dept., Santa Chiara Hospital, Trento, Italy

Introduction

Several methods allow to reach cardioversion of atrial fibrillation (AF): they include a surgical or pharmacological approach, external electrical shock, ablation of abnormal pathways, and, quite recently, internal electrical shock delivered by an implantable device.

Since consistent problems are present in all these methods, we are proposing a possible implantable cardioverter based on clinical observation that any drug can reach and affect myocardial function throughout venous cardiac circulation. The rationale is that termination of AF can be achieved by means of infusion of an antiarrhythmic drug directly into the left atrium effluents, minimizing the amount of drug and reducing, in this way, side effects of drug itself.

Since september 1995 we began an experimental investigation in order to achieve a possible cardioversion of AF by means of minimal amount of dedicated drug retroinfused into the coronary sinus (CS).

Rationale was to obtain an elevated drug concentration in that portion of CS where effluents from the left atrium empty, the equivalent in the humans of the oblique Marshall vein (OMV). In fact through this vein almost of venous blood flowing back from the left atrium reaches the right atrium: retroinfusion of the drug through this system should reach the left atrium so stopping atrial flutter and or fibrillation immediately after its onset.