This study was supported in part by “Fondo d'Ateneo per la Ricerca” of the University of Insubria-Varese for the year 2000.
Electroanatomic Analysis of Sinus Impulse Propagation in Normal Human Atria
Version of Record online: 12 AUG 2003
© Futura Publishing Company, Inc. 2002
Journal of Cardiovascular Electrophysiology
Volume 13, Issue 1, pages 1–10, January 2002
How to Cite
DE PONTI, R., HO, S. Y., SALERNO-URIARTE, J. A., TRITTO, M. and SPADACINI, G. (2002), Electroanatomic Analysis of Sinus Impulse Propagation in Normal Human Atria. Journal of Cardiovascular Electrophysiology, 13: 1–10. doi: 10.1046/j.1540-8167.2002.00001.x
- Issue online: 12 AUG 2003
- Version of Record online: 12 AUG 2003
- Manuscript received 21 June 2001; Accepted for publication 28 November 2001.
- Cited By
- atrial conduction;
- electroanatomic mapping;
- sinoatrial node;
- Bachmann's bundle;
- interatrial conduction;
- atrial arrhythmia mechanism
Sinus Impulse Propagation in Normal Human Atria.Introduction: Better understanding of atrial propagation during sinus rhythm (SR) in normal hearts under the most normal physiologic conditions may be propaedeutic to pathophysiologic studies of complex atrial arrhythmias. In this study, qualitative and quantitative analyses of sinus impulse propagation in both atria were performed by electroanatomic mapping in patients with no organic heart disease who were undergoing an electrophysiologic procedure.
Methods and Results: Seven patients (5 men and 2 women; age 37 ± 11 years) undergoing ablation of a left-sided accessory pathway were considered. Associated heart disease and coexisting atrial arrhythmias were excluded. After obtaining informed consent, electroanatomic mapping of both atria was performed during SR using a nonfluoroscopic system in the postablation phase. Mapping was accomplished in all patients with no complications. Qualitative analysis showed that sinus impulse propagation gives a reproducible activation pattern with minor individual variations. During interatrial propagation, two breakthroughs (anterior and posterior) in the left atrium are observed in the majority of cases. The anterior breakthrough, which reflects conduction over Bachmann's bundle, is predominant and shows a peculiar “preexcitation-like” endocardial activation pattern. Quantitative analysis showed minimal individual variations of propagation time intervals. Atria are activated simultaneously for 65% ± 9% of the duration of the atrial systolic time interval.
Conclusion: In normal humans, electroanatomic mapping of SR identifies a typical and reproducible propagation pattern during SR. Bachmann's bundle plays the most important role in interatrial propagation. Atria are activated simultaneously by sinus impulse for a relevant portion of the systolic time interval.