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Respiratory variability of sinus node activation in humans: insights from ultra-high-density mapping

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Abstract

Purpose

Experimental data suggest that shifts in the site of origin of the sinus node (SN) correlate with changes in heart rate and P wave morphology. The direct visualization of the effect of respiration on SN electrical activation has not yet been reported in humans. We aimed to measure the respiratory shifting of the SN activation using ultra-high-density mapping.

Methods

Sequential right atrial (RA) activation mapping during sinus rhythm (SR) was performed. Three maps were acquired for each patient: basal end-expiratory (Ex), end-inspiratory (Ins), and end-expiratory under isoproterenol (Iso). The earliest activation site (EAS) was defined as the earliest unipolar electrograms (EGM) with a QS pattern and was localized with respect to the ostium of the superior vena cava (SVC; negative values if EAS inside the SVC).

Results

In 20 patients, 49 maps in SR were acquired (20 Ex, 19 Ins, and 10 Iso). Expiratory (944 ± 227 ms) and inspiratory (946 ± 227 ms) SR cycle lengths were similar, but shortened under isoproterenol (752 ± 302 ms). Activation was unicentric in 33 maps and multicentric in 16: 4 during Ins, 10 during Ex, and 2 Iso. EAS location was significantly more cranial in expiration than in inspiration (0.27 ± 12.1 vs 5 ± 11.51 mm, p = 0.01). Iso infusion tends to induce a supplemental cranial shift (−4.07 ± 15.83 vs 0.27 ± 12.7 mm, p = 0.21). EAS were found in SVC in 22.7% of maps (30% Ex, 21% Ins, and 8% Iso).

Conclusion

Inspiration induces a significant caudal shift of the earliest sinus activation. In one-third of the cases, sinus rhythm earliest activation is inside the SVC.

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Abbreviations

EAS:

Earliest activation site

EGM:

Electrogram

Ex:

Basal end-expiration

Ins:

Basal end-inspiration

Iso:

End-expiratory under Isoproterenol

RA:

Right atrium

RF:

Radiofrequency

RSA:

Respiratory sinus arrhythmia

SBO:

Sinus break-out

SN:

Sinus node

SR:

Sinus rhythm

SVC:

Superior vena cava

UHD:

Ultra-high-density

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Funding

This project received funding from the Scientific Center of Monaco.

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Author notes

  1. G. Garret and D. G. Laţcu contributed equally to this work.

Authors and Affiliations

  1. Service de Cardiologie, Centre Hospitalier Princesse Grace, Monaco, Monaco

    G. Garret, D. G. Laţcu, S. S. Bun, B. Enache, K. Hasni, A. Moustfa & N. Saoudi

  2. Centre Hospitalier de Cannes, Service de Cardiologie, 15 Avenue des Broussailles, 06400, Cannes, France

    G. Garret

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Correspondence to G. Garret.

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Conflict of interest

Dr. Latcu and Dr. Bun have received moderate consulting and lecture fees from Boston Scientific. Other authors: No disclosures.

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This study was approved by the Hospital Ethics Committee. Each patient gave his written consent for the invasive procedure and the study.

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Each patient gave his written consent for the publication of this study.

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Garret, G., Laţcu, D.G., Bun, S.S. et al. Respiratory variability of sinus node activation in humans: insights from ultra-high-density mapping. J Interv Card Electrophysiol 63, 49–58 (2022). https://doi.org/10.1007/s10840-021-00946-8

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