Document Detail

Characteristics of right atrial activation during coronary sinus pacing.
MedLine Citation:
PMID:  12212700     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Anatomic and electrical connections between the left atrium and right atrium (RA) have been described. The relationship between coronary sinus (CS) pacing site and RA activation has not been examined. METHODS AND RESULTS: Fifteen anesthetized swine underwent high-density noncontact mapping of the RA during pacing from up to five different sites within the CS. Isopotential mapping identified the site of earliest RA depolarization and the pattern of subsequent activation. Hearts were excised and endocardial dissection performed. Earliest RA activation occurred at the CS os with proximal CS pacing sites and at Bachmann's bundle at distal pacing sites. The mean depth at which a shift in earliest RA activation site occurred was 46 +/- 13 mm (range 21 to 63 mm). RA activation times following earliest activation at the CS and Bachmann's bundle were 40 +/- 4 msec and 51 +/- 6 msec (P < 0.002). Conduction delay or block was recorded at the lateral cavotricuspid isthmus, terminal crest, and tendon of Todaro. Latest RA activation always occurred in the high anterolateral atrium after ascending the anterolateral wall. The lateral RA was activated by the wavefront that traversed the posterior wall rather than by the wavefront crossing the cavotricuspid isthmus, even with earliest RA activation at the CS os. CONCLUSION: The site of earliest RA activation during CS pacing is dependent upon the pacing depth within the CS. In the porcine heart, areas of conduction delay influence RA activation patterns and timings. These findings may have implications for patients undergoing assessment of radiofrequency ablation of atrial flutter.
Tim R Betts; Siew Yen Ho; Damian Sanchez-Quintana; Paul R Roberts; Robert H Anderson; John M Morgan
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  13     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-09-05     Completed Date:  2003-01-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  794-800     Citation Subset:  IM    
Southampton University Hospitals, United Kingdom.
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MeSH Terms
Body Surface Potential Mapping
Cardiac Pacing, Artificial*
Coronary Vessels / physiopathology*,  surgery*
Electric Stimulation
Electrodes, Implanted
Electrophysiologic Techniques, Cardiac
Heart Atria / physiopathology*,  surgery*
Heart Conduction System / physiopathology,  surgery
Heart Septum / physiopathology,  surgery
Models, Animal
Models, Cardiovascular
Treatment Outcome
Vena Cava, Inferior / physiopathology,  surgery
Vena Cava, Superior / physiopathology,  surgery

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