Open AccessWavefront direction and cycle length affect left atrial electrogram amplitude
Author(s) -
Iso Kazuki,
Watanabe Ichiro,
Kogawa Rikitake,
Okumura Yasuo,
Nagashima Koichi,
Takahashi Keiko,
Watanabe Ryuta,
Arai Masaru,
Ohkubo Kimie,
Nakai Toshiko,
Hirayama Atsushi,
Nikaido Mizuki
Publication year - 2017
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2017.01.001
Subject(s) - coronary sinus , cardiology , medicine , atrial fibrillation , atrium (architecture) , sinus rhythm , pulmonary vein , amplitude , optics , physics
Background The relationship between atrial electrogram (EGM) characteristics in atrial fibrillation (AF) and those in sinus rhythm (SR) are generally unknown. The activation rate and direction may affect EGM characteristics. We examined characteristics of left atrial (LA) EGMs obtained during pacing from different sites. Methods The study included 10 patients undergoing pulmonary vein isolation for AF. Atrial EGMs were recorded from a 64‐pole basket catheter placed in the LA, and bipolar EGM amplitudes from the distal electrode pair (1–2) and proximal electrode pair (6–7) from 8 splines were averaged. The high right atrium (HRA), proximal coronary sinus (CSp), and distal coronary sinus (CSd) were paced at 600 ms and 300 ms. Results When the LA voltage at SR was ≥1.5 mV, bipolar voltages of the HRA were greater than those of the CSp, which were greater than those of the CSd, regardless of the pacing cycle length. The shorter pacing cycle length resulted in a reduction of the LA EGM voltage at sites of SR voltage ≥1.5 mV, but no significant difference was seen at sites where the SR EGM amplitude was between >0.5 and <1.5 mV. No significant differences were seen in intra‐basket conduction times between pacing cycle lengths of 600 ms and 300 ms at any pacing site. Conclusion The rate and direction‐dependent reduction of the amplitude of atrial EGMs may explain, in part, the voltage discordance during SR and AF.