Electroanatomic Analysis of Sinus Impulse Propagation in Normal Human Atria

Ponti, Roberto De; Ho, Siew Yen; Salerno‐Uriarte, Jorge A.; Tritto, T. Massimo; Spadacini, Giammario

doi:10.1046/j.1540-8167.2002.00001.x

Cited by 134 publications

(97 citation statements)

References 8 publications

(10 reference statements)

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“…The activation spread predicted here on the basis of myofiber architecture corresponds very closely to atrial activation patterns mapped in humans, 17 dogs, 18,19 and sheep 20 -22 in sinus rhythm or during electric stimulation adjacent to the SAN. In particular, the model replicates normal propagation through the anterior and posterior LA walls during sinus rhythm or stimulation adjacent to the SAN with final activation adjacent to the left inferior PV observed in humans 17 and dogs.…”

Section: Effects Of Atrial Myofiber Architecture On Electric Activationsupporting

confidence: 71%

An Image-Based Model of Atrial Muscular Architecture

Zhao

Butters²,

Zhang³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Computer models that capture key features of the heterogeneous myofiber architecture of right and left atria and interatrial septum provide a means of investigating the mechanisms responsible for atrial arrhythmia. The data necessary to implement such models have not previously been available. The aims of this study were to characterize surface geometry and myofiber architecture throughout the atrial chambers and to investigate the effects of this structure on atrial activation. Methods and Results-Atrial surface geometry and myofiber orientations were reconstructed in 3D at 50ϫ50ϫ50-m

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Section: Effects Of Atrial Myofiber Architecture On Electric Activationsupporting

confidence: 71%

An Image-Based Model of Atrial Muscular Architecture

Zhao

Butters²,

Zhang³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…In fact, the CARTO maps in the present study agree substantially with those obtained both by De Ponti et al 21 and by Harrild and Henriquez 13 and Chang et al 22 using computer models.…”

Section: Activation Propagation and CV In The Ra And In The Ktsupporting

confidence: 92%

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Pandozi

Ficili

Galeazzi

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-The presence of a conduction block at the level of the Koch triangle (KT) and the origin of the multicomponent potentials inside this area are controversial issues. We investigated the propagation of the sinus impulse into the KT and the characteristics of multicomponent potentials recorded in that area in patients with and without atrioventricular nodal reentrant tachycardia (AVNRT). Methods and Results-Thirty-two patients (16 with AVNRT, 16 without AVNRT) underwent a sinus rhythm electroanatomic mapping of the right atrium (RA). Conduction velocities in the RA and in the KT were evaluated quantitatively on activation maps and qualitatively on isochronal and propagation maps. The presence, location, and timing of different types of multicomponent potentials were evaluated. A mean of 149Ϯ44 points were sampled in the RA, whereas a mean of 79Ϯ21 points were collected inside the KT. Propagation block at the level of crista terminalis was not found in any patient, whereas slow conduction inside the KT was found in all (

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“…14,16 A recent study also identified posteroseptal pathways involved in SR activation of the LA endocardium. 21 Although Bachmann's bundle appeared to be the predominant interatrial connection, technical limitations may have reduced the accuracy of mapping in the posteroseptal LA and the region of the RIPV ostium. 22 The present study has shown that there are indeed multiple connections capable of right-to-left atrial conduction and that posterior communications play a major role, in contrast to left-to-right conduction.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Left Atrial Activation in the Intact Human Heart

et al. 2003

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Background-The patterns of activation of the human left atrium (LA), how they relate to atrial myocardial architecture, and their role in arrhythmogenesis remain largely unknown. Methods and Results-Left atrial endocardial activation was mapped in 19 patients with a percutaneous noncontact mapping system. Earliest endocardial breakthrough during sinus rhythm (SR) occurred more frequently in the septal (63%, principally posteroseptal) than anterosuperior (37%) LA and varied little with isoproterenol or high right atrial pacing rate. Regardless of site of breakthrough, LA activation was characterized in all patients by propagation around a variably complete line of functional conduction block, descending on the posterior wall from the roof, passing between the ostia of the superior and then inferior pulmonary veins (PVs) before turning septally, passing below the oval fossa, and merging further anteriorly with the septal mitral annulus. Examination of the myocardial architecture in 10 normal adult postmortem hearts revealed an abrupt change in subendocardial fiber orientation along a line following the same course. During episodes of focal initiation of atrial fibrillation (AF), interaction was observed between wavefronts entering the LA from PVs and this functional line of conduction block that resulted in LA macroreentry or formation of daughter wavefronts. Conclusions-The LA endocardium has complex but characteristic patterns of activation during sinus rhythm, pacing, and AF initiation by PV ectopy that are determined largely by the functional properties of atrial musculature. These findings have important implications for both pacing and ablative strategies for the prevention of initiation of AF.

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Electroanatomic Analysis of Sinus Impulse Propagation in Normal Human Atria

Cited by 134 publications

References 8 publications

An Image-Based Model of Atrial Muscular Architecture

An Image-Based Model of Atrial Muscular Architecture

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Characterization of Left Atrial Activation in the Intact Human Heart

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