| High Density Epicardial Mapping of the Pulmonary Vein - Left Atrial Junction in Humans: Insights into Mechanisms of Pulmonary Vein Arrhythmogenesis. | |
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MedLine Citation:
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PMID: 21907170 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2011-9-7 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: - ISSN: 1556-3871 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011. Published by Elsevier Inc. |
Affiliation:
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The Department of Cardiology, The Royal Melbourne Hospital and The Department of Medicine, University of Melbourne, Melbourne, Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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