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Three-dimensional mapping of right atrial activation during sinus rhythm and its relationship to endocardial architecture

Three-dimensional mapping of right atrial activation during sinus rhythm and its relationship to endocardial architecture
Three-dimensional mapping of right atrial activation during sinus rhythm and its relationship to endocardial architecture
Introduction: Previous mapping studies of right atrial (RA) activation during sinus rhythm have been limited by the use of epicardial electrode plaques in open chest subjects or microelectrodes in the excised heart. This study describes global RA endocardial activation patterns using high-density mapping and compares the results with underlying endocardial architecture.
Methods and Results: Noncontact mapping of the RA was performed in 21 anesthetized swine. Isopotential and isochronal maps were superimposed upon three-dimensional reconstructions of RA geometry. Hearts were excised and endocardial dissection performed. Two patterns of RA activation were recorded. The site of earliest endocardial activation occurred either laterally at a position consistent with the terminal crest or superiorly at the junction between the superior caval vein and RA appendage. The subsequent spread of depolarization followed the longitudinal orientation of muscle fibers. Areas of conduction delay and block were seen at the junction between the terminal crest and posterior wall, the cavotricuspid isthmus, and around the margins of the triangle of Koch. Endocardial dissection at these sites demonstrated complex fiber orientation. A lateral site of earliest activation demonstrated a more prominent display of conduction delay or block.
Conclusion: The spread of the sinus impulse follows endocardial myofiber orientation and is dictated by the site of earliest activation. Even during sinus rhythm, anisotropic conduction results in areas of conduction block or delay. These findings have implications in the development of reentrant arrhythmias and may influence surgical or electrophysiologic procedures.
1045-3873
1152-1159
Betts, Tim R.
deac7746-b99a-4316-a312-16a3e43ab0ec
Ho, Siew Yen
2183d00f-cdd7-4c3c-81ac-d10dfe2b5d62
Sanchez-Quintana, Damian
643f4106-126a-499e-bdd3-03c9eb9d4776
Roberts, Paul R.
193431e8-f9d5-48d6-8f62-ed9052b2571d
Anderson, Robert H.
0bfb7485-0146-471b-a3b0-ac63678b9778
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Betts, Tim R.
deac7746-b99a-4316-a312-16a3e43ab0ec
Ho, Siew Yen
2183d00f-cdd7-4c3c-81ac-d10dfe2b5d62
Sanchez-Quintana, Damian
643f4106-126a-499e-bdd3-03c9eb9d4776
Roberts, Paul R.
193431e8-f9d5-48d6-8f62-ed9052b2571d
Anderson, Robert H.
0bfb7485-0146-471b-a3b0-ac63678b9778
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680

Betts, Tim R., Ho, Siew Yen, Sanchez-Quintana, Damian, Roberts, Paul R., Anderson, Robert H. and Morgan, John M. (2002) Three-dimensional mapping of right atrial activation during sinus rhythm and its relationship to endocardial architecture. Journal of Cardiovascular Electrophysiology, 13 (11), 1152-1159. (doi:10.1046/j.1540-8167.2002.01152.x).

Record type: Article

Abstract

Introduction: Previous mapping studies of right atrial (RA) activation during sinus rhythm have been limited by the use of epicardial electrode plaques in open chest subjects or microelectrodes in the excised heart. This study describes global RA endocardial activation patterns using high-density mapping and compares the results with underlying endocardial architecture.
Methods and Results: Noncontact mapping of the RA was performed in 21 anesthetized swine. Isopotential and isochronal maps were superimposed upon three-dimensional reconstructions of RA geometry. Hearts were excised and endocardial dissection performed. Two patterns of RA activation were recorded. The site of earliest endocardial activation occurred either laterally at a position consistent with the terminal crest or superiorly at the junction between the superior caval vein and RA appendage. The subsequent spread of depolarization followed the longitudinal orientation of muscle fibers. Areas of conduction delay and block were seen at the junction between the terminal crest and posterior wall, the cavotricuspid isthmus, and around the margins of the triangle of Koch. Endocardial dissection at these sites demonstrated complex fiber orientation. A lateral site of earliest activation demonstrated a more prominent display of conduction delay or block.
Conclusion: The spread of the sinus impulse follows endocardial myofiber orientation and is dictated by the site of earliest activation. Even during sinus rhythm, anisotropic conduction results in areas of conduction block or delay. These findings have implications in the development of reentrant arrhythmias and may influence surgical or electrophysiologic procedures.

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Published date: 2002

Identifiers

Local EPrints ID: 25256
URI: http://eprints.soton.ac.uk/id/eprint/25256
ISSN: 1045-3873
PURE UUID: ede4681b-65c6-4484-8c0a-2dbf9b02fd62

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Date deposited: 06 Apr 2006
Last modified: 15 Jul 2019 19:16

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