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High Density Epicardial Mapping of the Pulmonary Vein - Left Atrial Junction in Humans: Insights into Mechanisms of Pulmonary Vein Arrhythmogenesis.
MedLine Citation:
PMID:  21907170     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The pulmonary veins (PV) and the PV-LA junction are established sources of triggers initiating AF. Additionally, they have been implicated in the maintenance of arrhythmia. OBJECTIVE: To undertake high-density electrophysiological characterization of the right superior PV-left atrial (PV-LA) junction in humans. METHODS: Mapping was performed in 18 patients undergoing cardiac surgery without a history of AF. A high-density epicardial plaque was positioned at the anterior RSPV covering 3 regions: LA, PV-LA junction and the PV. Isochronal maps were created during: 1. SR; 2. LA pacing (LA-Pace); 3. PV pacing (PV-Pace); 4. LA programmed stimulation (LA-PES); 5.PV programmed stimulation (PV-PES). Regional differences in conduction slowing/block (CS/CB) and the prevalence of fractionated signals (FS) and double potentials (DPs) were assessed. RESULTS: A region of isochronal crowding representing CS/CB developed at the PV-LA junction in 84% of maps. 3 distinct activation patterns were seen. Pattern-1: Uniform SR activation without CS/CB. LA-Pace and PES caused 1-2 lines of isochronal crowding (CS/CB) at the PV-LA junction. Pattern-2: CS/CB occurred at the PV-LA junction in SR. LA/PV-Pace and LA/PV-PES caused an increase in CS/CB at the PV-LA junction with widely-split DPs and FS. Pattern-3: A single incomplete line of CS at the PV-LA junction in SR. With LA/PV pacing and LA/PV-PES multiple lines (≥3) of CS/CB developed at the PV-LA junction with evidence of circuitous activation and a marked increase in DP and FS. CONCLUSION: High-density epicardial mapping of the right superior pulmonary vein demonstrates marked functional conduction delay and circuitous activation patterns at the PV-LA junction, creating the substrate for re-entry.
Authors:
Geoffrey Lee; Steven Spence; Andrew Teh; John Goldblatt; Marco Larombina; Victoria Atkinson; Robin Brown; Joseph B Morton; Prashanthan Sanders; Peter M Kistler; Jonathan M Kalman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-7
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
The Department of Cardiology, The Royal Melbourne Hospital and The Department of Medicine, University of Melbourne, Melbourne, Australia.
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