Inter-atrial epicardial muscular fibers as a possible source of atrial tachyarrhythmias

Hattori, Masayuki; Baba, Masakazu; Hasebe, Hideyuki; Yoshida, Kentaro

doi:10.1016/j.jccase.2022.12.003

Cited by 2 publications

(1 citation statement)

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“…A similar phenomenon as in Case 3 was observed in the intercaval bundle connecting the right-sided PV carina and RA posterior wall and was recently reported by our institution. 13 A 22-year-old woman underwent catheter ablation of frequent premature atrial contractions (PACs). RF applications from the RA transiently suppressed, and those from the LA finally eliminated, these PACs.…”

Section: Casementioning

confidence: 99%

Unidirectional conduction characterizing epicardial connections in patients with atrial tachyarrhythmias

Yoshida,

Hasebe,

Hattori

et al. 2023

Cardiovasc electrophysiol

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IntroductionElectrophysiological characteristics of epicardial connections (ECs) in atria and pulmonary veins (PVs) are unclear despite their important contributions to atrial fibrillation (AF). Unidirectional conduction associated with source‐sink mismatch can occur in ECs due to their fine fibers with abrupt changes in orientation. We detailed the prevalence and electrophysiological characteristics of unidirectional conduction in the atria and investigated its association with the clinical manifestation of AF.MethodsThis study retrospectively reviewed electrophysiological studies and radiofrequency catheter ablation in 261 consecutive patients with AF.ResultsUnidirectional conduction was observed during ablation encircling the PVs in eight (3.1%) patients, and all occurred in the suspected (N = 4) or definitively (N = 4) recognized ECs. These ECs included three intercaval bundles, four septopulmonary bundles, and one Marshall bundle, and were first manifested in a second procedure in 6 (75%) patients. The unidirectional property was from PV to atrium (exit conduction) in all intercaval bundles and three septopulmonary bundles, and from atrium to PV (entrance conduction) in the remaining two bundles. Intercaval bundles acted as a limb of bi‐atrial macro‐reentrant tachycardia (50%, three of the six including previous cases). Ablation of the exit outside the PVs, including the right atrium, eliminated ECs in three (38%) patients. All patients remain free from arrhythmia recurrence after a mean 13‐month follow‐up.ConclusionA unidirectional conduction property was closely associated with the EC, as estimated by histological findings. Recognition of this fact by electrophysiologists may help to clarify mechanisms for AF and atrial tachycardia and guide the creation of efficient and safe ablation lesion sets.

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Section: Casementioning

confidence: 99%