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Atrial activation mapping in sinus rhythm in the clinical electrophysiology laboratory: observations during Bachmann's bundle block.

Abstract：

INTRODUCTION:The high posterolateral right atrium (RA) is considered the "sinus node area," but we lack information on endocardial atrial activation in sinus rhythm. We studied RA and left atrial (LA) endocardial activation in the electrophysiology laboratory. METHODS AND RESULTS:Thirty-five patients (21 men) aged 47 +/- 16.4 years (mean +/- SD) underwent RA mapping (22.2 +/- 3.8 points). In 21 patients, LA activation was mapped (11.1 +/- 3.9 points) through the coronary sinus (CS), right pulmonary artery, and/or a patent oval foramen. Fourteen patients had atrial arrhythmias, and 3 an ECG pattern of Bachmann's bundle block. Endocardial RA activation preceded P wave in 5 (-14 +/- 4.2 ms), coincided in 11, and followed P onset in 18 (16.7 +/- 6.6 ms). Location of the zero point varied from the superior vena cava to the low RA and from lateral to paraseptal RA. In 19 patients, activation started simultaneously in 2 to 5 points located >or=1 cm apart. RA activation was descending in most, but in 3 with low onset there was collision in the anterior and septal walls. In 15 of 21 patients, descending LA activation dominated, ending in the mid CS in 12, proximal CS in 1, and simultaneously throughout the CS in 2. In 3 with Bachmann's bundle block, CS activation was ascending and in 2 double potentials were recorded from the LA roof. CONCLUSION:During stable sinus rhythm, RA activation can start in different areas or simultaneously over large areas resulting in different activation patterns, both in the RA and the LA. LA activation is predominantly descending, but in Bachmann's bundle block it becomes ascending, and double potentials suggest a location of block in the LA roof.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Cosío FG,Martín-Peñato A,Pastor A,Núñez A,Montero MA,Cantale CP,Schames S

doi

10.1046/j.1540-8167.2004.03403.x

keywords:

subject

Has Abstract

pub_date

2004-05-01 00:00:00

pages

524-31

issue

eissn

1045-3873

issn

1540-8167

pii

JCE03403

journal_volume

pub_type

临床试验,杂志文章

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Atrial activation mapping in sinus rhythm in the clinical electrophysiology laboratory: observations during Bachmann's bundle block.