Dataset Information

High-resolution 3D mapping of epicardial conduction during Marshall bundle-related atrial tachycardia.

ABSTRACT: A 73-year-old woman was admitted for atrial tachycardia (AT) ablation. The activation map and pacing study indicated that the AT propagated around the left pulmonary vein and that the Marshall bundle (MB) bypassed the scar area of the left pulmonary vein ridge and mitral isthmus. The Rhythmia Mapping System revealed double potentials propagated along the assumed position of the MB. The mapping system includes a confidence mask that can be used to visually identify low-confidence areas of the map based upon extremely low-voltage signals. Given the low-voltage area in the endocardial side, the epicardial conduction was emphasized.

SUBMITTER: Hojo R

PROVIDER: S-EPMC6009767 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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High-resolution 3D mapping of epicardial conduction during Marshall bundle-related atrial tachycardia.

Hojo Rintaro R Fukamizu Seiji S Miyazawa Satoshi S Kawamura Iwanari I

Journal of arrhythmia 20180430 3

A 73-year-old woman was admitted for atrial tachycardia (AT) ablation. The activation map and pacing study indicated that the AT propagated around the left pulmonary vein and that the Marshall bundle (MB) bypassed the scar area of the left pulmonary vein ridge and mitral isthmus. The Rhythmia Mapping System revealed double potentials propagated along the assumed position of the MB. The mapping system includes a confidence mask that can be used to visually identify low-confidence areas of the map ...[more]

PMID: 29951148

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Project description:BACKGROUND:The influence of underlying heart disease or presence of atrial fibrillation (AF) on atrial excitation during sinus rhythm (SR) is unknown. We investigated atrial activation patterns and total activation times of the entire atrial epicardial surface during SR in patients with ischemic and/or valvular heart disease with or without AF. METHODS AND RESULTS:Intraoperative epicardial mapping (N=128/192 electrodes, interelectrode distances: 2 mm) of the right atrium, Bachmann's bundle (BB), left atrioventricular groove, and pulmonary vein area was performed during SR in 253 patients (186 male [74%], age 66±11 years) with ischemic heart disease (N=132, 52%) or ischemic valvular heart disease (N=121, 48%). As expected, SR origin was located at the superior intercaval region of the right atrium in 232 patients (92%). BB activation occurred via 1 wavefront from right-to-left (N=163, 64%), from the central part (N=18, 7%), or via multiple wavefronts (N=72, 28%). Left atrioventricular groove activation occurred via (1) BB: N=108, 43%; (2) pulmonary vein area: N=9, 3%; or (3) BB and pulmonary vein area: N=136, 54%; depending on which route had the shortest interatrial conduction time (P<0.001). Ischemic valvular heart disease patients more often had central BB activation and left atrioventricular groove activation via pulmonary vein area compared with ischemic heart disease patients (N=16 [13%] versus N=2 [2%]; P=0.009 and N=86 [71%] versus N=59 [45%]; P<0.001, respectively). Total activation times were longer in patients with AF (AF: 136±20 [92-186] ms; no AF: 114±17 [74-156] ms; P<0.001), because of prolongation of right atrium (P=0.018) and BB conduction times (P<0.001). CONCLUSIONS:Atrial excitation during SR is affected by underlying heart disease and AF, resulting in alternative routes for BB and left atrioventricular groove activation and prolongation of total activation times. Knowledge of atrial excitation patterns during SR and its electropathological variations, as demonstrated in this study, is essential to further unravel the pathogenesis of AF.

Dataset Information

High-resolution 3D mapping of epicardial conduction during Marshall bundle-related atrial tachycardia.

Publications

High-resolution 3D mapping of epicardial conduction during Marshall bundle-related atrial tachycardia.

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