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Left atrial appendage activity masquerading as pulmonary vein potentials.

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Far-field left atrial appendage (LAA) activity impacts left pulmonary vein (PV) electrograms. Pacing helps differentiate LAA and left atrial (LA) signals, aiding ablation strategies for persistent potentials.

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Area of Science:

  • Electrophysiology
  • Cardiac Anatomy
  • Interventional Cardiology

Background:

  • Pulmonary vein (PV) potentials often persist after ablation.
  • Left atrial appendage (LAA) activity can contaminate PV electrograms.

Purpose of the Study:

  • To differentiate the origin of non-eliminated potentials in left PVs.
  • To identify the role of LAA and left atrial (LA) activity in PV electrograms.

Main Methods:

  • Analysis of PV electrograms during sinus rhythm, coronary sinus pacing, and LAA pacing.
  • PV and LAA angiography to assess anatomical proximity.

Main Results:

  • A low-amplitude potential in the left superior PV correlated with posterior LAA activation and proximity.
  • A less distinct potential in the left inferior PV correlated with inferior LA activation, despite greater distance from the LAA.

Conclusions:

  • Far-field LAA activity contributes to left superior PV electrograms.
  • Inferior LA potentials are identified in the left inferior PV.
  • LAA and coronary sinus pacing can help distinguish these extravenous potentials.