Electrogram analysis at the His bundle region and the proximal coronary sinus as a tool to predict left atrial origin of focal atrial tachycardias
| Autor: | Gábor Bencsik, Gergely Klausz, Tamás Forster, Rodrigo Gallardo, László Sághy, Vassil Traykov, Attila Makai, Tchavdar N. Shalganov, Róbert Pap |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Tachycardia Ectopic Atrial Tachycardia Bundle of His medicine.medical_specialty medicine.medical_treatment Catheter ablation Sensitivity and Specificity Predictive Value of Tests Focal atrial tachycardia Physiology (medical) Internal medicine Septal medicine Humans Heart Atria Coronary sinus musculature Atrial tachycardia Coronary sinus Aged Aged 80 and over Atrium (architecture) business.industry Coronary Sinus Middle Aged Ablation medicine.anatomical_structure Electrogram analysis Predictive value of tests Catheter Ablation Cardiology Female His bundle medicine.symptom Electrophysiologic Techniques Cardiac Cardiology and Cardiovascular Medicine business |
| Zdroj: | Europace. 13:1022-1027 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eur077 |
| Popis: | Aims Early activation at the His bundle (HB) region or proximal coronary sinus (CS) during focal atrial tachycardias (FATs) often necessitates biatrial mapping. Analysis of CS electrograms (EGMs) consisting of a near-field (N) component from CS musculature and a far-field (F) component from left atrial (LA) myocardium can uncover LA activation preceding right atrial (RA) activation. A similar pattern might be observed at the HB. Methods and results Eight patients underwent RA and LA pacing testing the hypothesis that N and F components originating from the RA and LA septum are present in the HB atrial EGM (Pacing group). In this group N preceded F (N–F sequence) in all, while F preceded N (F–N sequence) in seven of eight patients during RA and LA pacing, respectively. Twenty-seven patients with FAT demonstrating earliest activation at the HB or proximal CS during limited RA mapping were also studied (FAT group). Two observers analysed the EGMs at the earliest site during FAT. They found an N–F sequence in 17 (94%) and 16 (89%) of 18 RA FAT and an F–N sequence in seven (78%) and eight (89%) of nine LA FAT, respectively. The F–N sequence predicted the need for LA access with a sensitivity of 78 and 89% and a specificity of 94 and 89%. Conclusion Near-field and F components from RA and LA activation can be identified in the HB atrial EGM. Earliest atrial EGM analysis at the HB or CS can predict the need for LA access during FAT ablation. |
| Databáze: | OpenAIRE |
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