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Change in distant atrial activation patterns during circumferential pacemapping of pulmonic vein ostium: implications
Sanjay Dixit1, Edward P Gerstenfeld, Robert W Rho
1University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Insights
Pacing from different sites around the pulmonary vein ostium creates consistent intracardiac activation patterns. This finding helps in accurately identifying the origin of atrial premature complexes during electrophysiology studies.
Area of Science:
- Electrophysiology
- Cardiac Electrophysiology
- Arrhythmia Mechanisms
Background:
- Intracardiac activation patterns from coronary sinus (CS) and right atrium (RA) during pulmonary vein (PV) pacing can identify the PV of origin for atrial premature complexes.
- Accurate template development requires understanding activation pattern variations when pacing from different sites within the same PV.
Purpose of the Study:
- To investigate variations in intracardiac activation patterns during pacing from different sites around the ostium of individual pulmonary veins.
- To determine if the location of pacing on the circumference of a PV influences the resulting activation patterns in the CS and RA.
Main Methods:
- In 25 patients undergoing atrial fibrillation (AF) ablation, pacing was performed from multiple bipoles on a Lasso catheter placed at the PV ostium.
- Multipolar catheters were positioned in the CS and posteromedial RA.
- Activation sequences and times in the CS and RA were recorded, and differences (CS - CT time) were calculated to assess interpolar variation.
Main Results:
- Pacing from different bipoles of the same PV did not alter the activation sequence in the CS (distal-to-proximal for left PVs, proximal-to-distal for right PVs).
- Significant interpolar variation (>/=25 msec difference in CS - CT time) was infrequent, occurring in only 5.3% of right superior PVs, 10% of left superior PVs, and 8.3% of left inferior PVs.
Conclusions:
- Intracardiac activation patterns during ostial pacing from individual PVs are consistent regardless of the pacing site's circumferential location.
- These consistent patterns can reliably serve as templates for identifying the PV of origin of atrial arrhythmias.
Introduction:
Unique intracardiac activation patterns recorded from multipolar catheters in the coronary sinus (CS) and posteromedial right atrium (RA) when pacing from ostium (os) of each pulmonic vein (PV) can serve as template for determining PV of origin of atrial premature complexes. Development of an accurate template requires knowledge of variations in activation pattern during pacing from different aspects of same PV.
Methods:
In 25 patients undergoing catheter ablation for AF, a decapolar Lasso mapping catheter was placed at PV os of interest and multipolar catheters were placed in CS and RA-medial to crista terminalis (CT). For each PV, pacing was performed from Lasso catheter poles 1 through 10. For each bipole paced, activation sequence in CS (proximal to distal & vice-versa) was assessed, activation time (pacing stimulus to earliest electrogram recorded in catheters in CS/along CT) was measured and difference (CS - CT time) was determined. Significant interpolar variation was defined as the difference between the shortest and longest CS - CT activation time of >/=25 msec when pacing from different bipoles of same PV.
Results:
In 59 PVs [19 right superior (RS), 20 left superior (LS), 8 right inferior (RI) and 12 left inferior (LI)], 259 bipoles were paced (median of 4 bipoles/PV). During circumferential PV pacing activation sequence in CS catheter was distal to proximal in 84.4% left-sided PVs (LSPV and LIPV) and proximal to distal in 92.6% right-sided PVs (RSPV and RIPV) with no change in activation sequence observed during pacing from different bipoles in same PV. Significant interpolar variation was observed with circumferential pacing in 1 of 19 RSPV (5.3%), 2 of 20 LSPV (10%), 1 of 12 LIPV (8.3%) and none of RIPV.
Conclusion:
Unique intracardiac activation patterns during ostial pacing from individual PV are not influenced by circumferential location of pacing site.
