Ablation on the mitral annulus for the treatment of atrial fibrillation: Anatomical consideration to prevent coronary injury

Coronary injury is a crucial complication of ablation on the posterior mitral annulus (PMA). Fifty autopsy heart specimens were classified into different types according to the final branch of the left circumflex coronary artery. The no-coronary area on the PMA was examined in each type. The posterolateral type was most common (39/50); the no-coronary area was located between 50.7%±6.5% and 83.5%±8.0% on the PMA. Ablations at 38.6%±5.2% (for catheter intervention) and the middle point (for surgery) appear safe for the obtuse marginal type but not for the posterolateral type. Thus, the no-coronary area should be considered during PMA ablation