Rate‐Dependent Block in the Sinus Venosa of the Swine Heart during Transverse Right Atrial Activation: Correlation Between Electrophysiologic and Anatomic Findings

González, Mario D.; Erga, Knut Ståle; Rivera, Jaime A.; Contreras, Leonardo J.; Mladinich, Christopher R.J.; Schultz, Jeff; Afonso, V.X.

doi:10.1046/j.1540-8167.2004.40483.x

Cited by 16 publications

(19 citation statements)

References 25 publications

(105 reference statements)

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“…35 The pronounced latency of the stimulus response in the SV may indicate that propagation of the early premature excitation is compromised in this region, probably because of its discontinuous structural characteristics. 16,17 …”

Section: Latency Of the Stimulus Response In The Svmentioning

confidence: 99%

“…[11][12][13][14][15] The SV is a smooth-walled structure and has no grossly distinguishable structural barriers, but there are abrupt changes in the thickness and orientation of the muscle fibers, as well as in the collagen content. 16,17 Such microscopic discontinuities have been suggested to provide a basis for rate-dependent conduction block during transverse atrial activation. However, information is limited as to the electrophysiological properties of the SV.…”

mentioning

confidence: 99%

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Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Harada

Osaka

Yokoyama

et al. 2009

Circ J

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Background: A functional line of conduction block is often observed in the sinus venosa (SV) during typical atrial flutter (AFL). Little information, however, is available as to the action potential characteristics in the SV with respect to the functional block. Methods and Results: Monophasic action potentials (MAPs) from the SV and lateral wall of the right atrium were recorded in 7 patients with paroxysmal AFL and 11 control patients. For both the control and AFL patients, the MAP duration at 90% repolarization (MAPD90) in the SV was longer, and the MAPD90 restitution slope was less steep than in the lateral wall. The MAPD90 in the SV in the AFL patients was slightly longer than that in the controls at the shortest cycle length (CL) tested (300 ms). However, the MAPD90s at longer CLs (350-700 ms), as well as the MAPD90 restitution slopes in the SV were comparable between the 2 groups. Conclusions: The MAPs in the SV are characterized by a long duration and flat restitution kinetics in humans. MAP properties to facilitate the development of conduction block in the SV are not appreciable in patients with paroxysmal typical AFL. (Circ J 2009; 73: 647 -653)

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Section: Latency Of the Stimulus Response In The Svmentioning

confidence: 99%

mentioning

confidence: 99%

Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Harada

Osaka

Yokoyama

et al. 2009

Circ J

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“…7 In that type of AT, the RA inferoseptum is the exit zone. Therefore, when the AT has a short cycle length with functional block at the posterior RA and crista terminalis, as in the present cases, [11][12][13][14] the surface ECG of the tachycardia can masquerade as isthmus-dependent AFL. Therefore, in this setting, it may be difficult to differentiate the ATs originating from the ER from those arising from the CS ostium.…”

Section: Discussionmentioning

confidence: 58%

“…Recent studies demonstrated that functional conduction block can occur at the cavo-tricuspid isthmus and postero-medial RA (sinus venosa region or crista terminalis) during pacing from the CS with short cycle lengths, and those rate-dependent conduction characteristics may play an important role in initiating and maintaining AFL. [11][12][13][14] Because the mean cycle length of focal AT is usually about 350 ms (range 250-500 ms), [3][4][5]7,8 an isoelectric line between the P waves usually can be found during the tachycardia. The P wave polarity of an AT with an exit zone at the RA inferoseptum is very similar to that of common AFL, with its exit zone also at the RA inferoseptum.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in the intraatrial activation pattern around the tricuspid annulus during pacing from the successful ablation site with different cycle lengths are shown in Fig 6. Pacing with a relatively longer cycle length of 400 ms resulted in clockwise activation around the tricuspid annulus (Fig 6, Left panel). However, pacing with a shorter cycle length of 210 ms, which was the However, during pacing with a shorter cycle length of 210 ms (Right panel), the same as the tachycardia cycle length, exhibited a counterclockwise activation around the tricuspid annulus, which might indicate functional block in the posterior portion of the right atrium (sinus venosa region 11,12 or crista terminalis 13 ). Abbreviations as in Figs 2,4. same as the AT cycle length, resulted in a counterclockwise activation around the annulus (Fig 6, Right panel).…”

Section: -Fr Octapolar Catheter (Cs 8) Was Positioned (Figs 5bc)mentioning

confidence: 93%

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Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

Ito

Tada

Nogami

et al. 2007

Circ J

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ost focal atrial tachycardias (ATs) originate from the right atrium (RA), the orifice of the pulmonary veins or the mitral annulus in the left atrium, 1-8 and radiofrequency (RF) catheter ablation has become an effective curative therapy. [1][2][3][4][5][6][7][8][9] In the RA, AT often originates along the crista terminalis, para-Hisian region, or from the inferoseptum, including the ostium of the coronary sinus (CS). [1][2][3][4][5][6][7] We describe 2 cases of AT arising from the RA inferoseptum. The remarkable characteristics of the tachycardia were that it masqueraded as isthmus-dependent, common atrial flutter (AFL). Case Reports Patient 1A 34-year-old woman with a 1-year history of incessant, exercise-induced palpitation attacks was admitted for evaluation of the tachycardia. A "saw-tooth" pattern in the inferior leads, and negative P-wave polarity in lead V6 and positive in lead V1 during the tachycardia with a cycle length of 210 ms mimicked common AFL (Fig 1A). After informed consent was obtained, catheter ablation was performed. At the beginning of the procedure, the patient had a normal sinus rhythm. The activation sequence across the cavo-tricuspid isthmus was in a clockwise direction during pacing from the CS ostium with a cycle length of 600 ms. The tachycardia could not be induced by programmed atrial stimuli. However, it could be induced by isoproterenol infusion, with a warm-up and cool-down phenomena, suggesting that the mechanism of this AT was automaticity. Activation mapping demonstrated a counterclockwise activation sequence around the tricuspid annulus during the tachycardia ( Fig 1B). The earliest atrial activation was found at a site near the CS ostium. The ablation catheter became stabilized at that site after clockwise torquing the catheter against the RA inferoseptum, away from the CS ostium. The local electrograms at that site exhibited double potentials, and a small, first potential preceded the atrial potential recorded at the CS ostium by 41 ms (Fig 2A). The tachycardia was eliminated by a single application of RF energy at that site. In the right anterior oblique view, the successful ablation site was posterior to the superior rim of the CS ostium, and corresponded to the Eustachian ridge (ER) (Fig 2B). The P-wave morphology and polarity during pacing from the successful ablation site were almost identical to those of the clinical tachycardia. During the tachycardia, a counterclockwise activation sequence was observed around the tricuspid annulus. However, during pacing from the ablation site with a longer cycle length of 600 ms after the ablation, the activation sequence across the isthmus was in the clockwise direction (Fig 2C). The patient was discharged without the need for medications and has done well with no AT recurrence during a 2-year follow-up period. Patient 2A 75-year-old man presented with a 2-year history of recurrent episodes of palpitation attacks. From the electrocardiographic findings recorded during the palpitations, he was diagnosed with common AFL. An intrav...

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Successful catheter ablation of postoperative atrial tachycardia with conduction disturbances: Assessment by late‐gadolinium enhancement magnetic resonance imaging and high‐resolution electro‐anatomical mapping

Nakasone

Kiuchi

Takami

et al. 2021

Clinical Case Reports

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Atrial tachycardia (AT) in the right atrium often occurs following open‐heart surgery. Catheter ablation for these AT is challenging and can lead to unintended conduction block. We performed late‐gadolinium enhancement magnetic resonance imaging (LGE‐MRI) prior to catheter ablation and predicted wavefront propagation during SR as well as the slow conduction zone during tachycardia. LGE‐MRI may assist predicting the conduction disturbance and reducing the risk of unexpected sinus exit block.

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Rate‐Dependent Block in the Sinus Venosa of the Swine Heart during Transverse Right Atrial Activation: Correlation Between Electrophysiologic and Anatomic Findings

Abstract: The sinus venosa and not the crista terminalis results in a rate-dependent line of block during transverse right atrial activation. The morphologic characteristics of the sinus venosa appear to facilitate block in this region.

Cited by 16 publications

References 25 publications

Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

Successful catheter ablation of postoperative atrial tachycardia with conduction disturbances: Assessment by late‐gadolinium enhancement magnetic resonance imaging and high‐resolution electro‐anatomical mapping

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Rate‐Dependent Block in the Sinus Venosa of the Swine Heart during Transverse Right Atrial Activation: Correlation Between Electrophysiologic and Anatomic Findings

Abstract: The sinus venosa and not the crista terminalis results in a rate-dependent line of block during transverse right atrial activation. The morphologic characteristics of the sinus venosa appear to facilitate block in this region.

Cited by 16 publications

References 25 publications

Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Action Potential Characteristics in the Sinus Venosa of Patients With and Without Atrial Flutter

Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

Successful catheter ablation of postoperative atrial tachycardia with conduction disturbances: Assessment by late‐gadolinium enhancement magnetic resonance imaging and high‐resolution electro‐anatomical mapping

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Product

Resources

About

Rate‐Dependent Block in the Sinus Venosa of the Swine Heart during Transverse Right Atrial Activation: Correlation Between Electrophysiologic and Anatomic Findings