Cardiovascular Diseases & Diagnosis

Coronary artery fistulas (CAF) are rare congenital or acquired coronary artery anatomic anomalies. They can develop from any of the three coronary arteries and drain into any of the cardiac chambers and great vessels thus creating an anatomic bypass of the myocardial capillary network. In our case, we present an 81-year-old who was referred for left heart catheterization after having found myocardial ischemia on perfusion imaging. Incidentally, he was found to have a fistula connection between the left circumflex coronary artery with the pulmonary artery. We present an atypical case of a circumflex coronary artery as a rare point of origin for a fistula with an incidence of about 18%.

Atrial fibrillation is not only the most common clinical arrhythmia, it is also one of the most challenging conditions to treat in day-to-day clinical practice. In particular, the persistent form of this condition is not easily amenable to traditional forms of therapy, whereas, the paroxysmal form is far more responsive to standard modes of treatment. In our relentless quest to find better solutions to overcome persistent atrial fibrillation, arguably the most promising of these currently appears to be electrical isolation of the left atrial appendage. Whilst surgical amputation of the left atrial appendage for stroke prevention has been practiced for more than half a century, only recently has attention gradually been shifting to electrical isolation of the left atrial appendage for the treatment of persistent atrial fibrillation. In this review article, we present compelling pieces of evidence for the use of this strategy, and the various ways in which it can be achieved.