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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Dr. Latcu and Dr. Bun have received moderate consulting and lecture fees from Boston Scientific. Other authors: No disclosures.
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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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DOI: https://doi.org/10.1007/s10840-021-00946-8