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Updated: Mar 2, 2026
High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
Epicardial-endocardial breakthrough during stable atrial macroreentry: Evidence from ultra-high-resolution
Bhupesh Pathik1, Geoffrey Lee1, Frédéric Sacher2
1Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Epicardial-endocardial breakthrough (EEB) was identified in patients with atrial macroreentry using high-density mapping. These breakthrough sites were critical for maintaining arrhythmias in some cases.
Area of Science:
- Electrophysiology
- Cardiac Mapping
- Atrial Fibrillation
Background:
- Epicardial-endocardial breakthrough (EEB) evidence is often inferred from mapping in atrial fibrillation patients.
- Focal activations can coexist with EEB in these patients.
Purpose of the Study:
- To investigate the discernment of EEB during stable right atrial (RA) macroreentry.
- Utilized high-density, high-spatial resolution 3-dimensional mapping.
Main Methods:
- Diagnosed macroreentry using 3D mapping and entrainment.
- Reviewed bipolar maps for EEB, defined by focal endocardial activation with radial spread and consistent timing.
- Calculated distance and conduction velocity from block lines to EEB sites.
Main Results:
- Fourteen EEB instances were observed in 26 patients, primarily on the posterior RA.
- EEB sites averaged 0.6 ± 0.2 cm² with specific unipolar electrogram morphology.
- Entrainment confirmed EEB sites within the reentrant circuit in 4 patients, critical in one.
Conclusions:
- EEB sites were demonstrated in stable atrial macroreentry.
- Findings were supported by entrainment confirmation and pacing during tachycardia.
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