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Evaluation of interatrial conduction pattern after pulmonary vein isolation using an ultrahigh-resolution electroanatomical mapping system

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Abstract

Interatrial conduction consists of various muscular bundles, including the Bachmann bundle. In this study, we investigated interatrial activation patterns using ultrahigh-resolution left atrial endocardial mapping. This study investigated 58 patients who underwent catheter ablation of atrial arrhythmia via an ultrahigh-resolution mapping system (Rhythmia) at our hospital from May 2020 to January 2021. Left atrial voltage maps and activation maps were acquired after the ablation procedure during right atrial appendage (RAA) pacing. We defined left atrial breakout sites (LABSs) as centrifugal activation patterns shown by the LUMIPOINT Activation Search Tool. The distance between each LABS in the left atrial anterior wall and the superior border of the interatrial septum (DLABS-IAS) was measured on the shell of the electroanatomical map, and anterior LABSs were divided equally into roof- and septal-side groups. Fifty-three (91%) patients underwent cryoballoon pulmonary vein isolation. Ultrahigh-resolution left atrial mapping was successfully performed in all patients (6831 ± 2158 points). A total of 82 LABSs were identified in left atrial anterior wall; 34 patients had single LABS and 24 patients had dual LABSs. The mean DLABS-IAS was 10.3 ± 9.6 mm. Seven patients also exhibited posterior LABS near the interatrial raphe below the right inferior pulmonary vein. Patients with a single roof-side LABS had significantly shorter left atrial activation times than those with a single septal-side LABS (81.6 ± 13.2 ms vs. 93.5 ± 13.7 ms, p < 0.05). Interatrial conduction patterns during RAA pacing varied between patients and affected the left atrial activation time.

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Acknowledgements

We greatly appreciate Mr. John Martin and the clinical engineers of our hospital.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Takayuki Sekihara, Shinsuke Miyazaki, Moeko Nagao, Shota Kakehashi, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Tomoya Eguchi, Kanae Hasegawa, Hiroyasu Uzui & Hiroshi Tada

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  1. Takayuki Sekihara
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  2. Shinsuke Miyazaki
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  3. Moeko Nagao
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  4. Shota Kakehashi
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  5. Moe Mukai
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  6. Daisetsu Aoyama
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  7. Minoru Nodera
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  8. Tomoya Eguchi
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  9. Kanae Hasegawa
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  10. Hiroyasu Uzui
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  11. Hiroshi Tada
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Correspondence to Takayuki Sekihara.

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Conflict of interest

Dr. Miyazaki belonged to the endowed departments of Medtronic, Boston, Abbott, and Japan Lifeline.

Ethics approval

The study protocol (opt-out method) was approved by the hospital’s institutional review board and the approval number was #20180040. The study complied with the Declaration of Helsinki.

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Sekihara, T., Miyazaki, S., Nagao, M. et al. Evaluation of interatrial conduction pattern after pulmonary vein isolation using an ultrahigh-resolution electroanatomical mapping system. Heart Vessels 37, 1425–1435 (2022). https://doi.org/10.1007/s00380-022-02040-z

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  • DOI: https://doi.org/10.1007/s00380-022-02040-z

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