Pambrun, Thomas; Derval, Nicolas; Duchateau, Josselin; Ramirez, F Daniel; Chauvel, Rémi; Tixier, Romain; Marchand, Hugo; Bouyer, Benjamin; Welte, Nicolas; André, Clémentine; Nakashima, Takashi; Nakatani, Yosuke; Kamakura, Tsukasa; Takagi, Takamitsu; Krisai, Philipp; Ascione, Ciro; Balbo, Conrado; Cheniti, Ghassen; Vlachos, Konstantinos; Bourier, Félix; Takigawa, Masateru; Kitamura, Takeshi; Frontera, Antonio; Meo, Marianna; Denis, Arnaud; Sacher, Frédéric; Hocini, Mélèze; Jaïs, Pierre; Haïssaguerre, Michel     «

Pambrun, Thomas; Derval, Nicolas; Duchateau, Josselin; Ramirez, F Daniel; Chauvel, Rémi; Tixier, Romain; Marchand, Hugo; Bouyer, Benjamin; Welte, Nicolas; André, Clémentine; Nakashima, Takashi; Nakatani, Yosuke; Kamakura, Tsukasa; Takagi, Takamitsu; Krisai, Philipp; Ascione, Ciro; Balbo, Conrado; Cheniti, Ghassen; Vlachos, Konstantinos; Bourier, Félix; Takigawa, Masateru; Kitamura, Takeshi; Frontera, Antonio; Meo, Marianna; Denis, Arnaud; Sacher, Frédéric; Hocini, Mélèze; Jaïs, Pierre; Haïssague...     »

BACKGROUND: An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics. OBJECTIVE: The purpose of this study was to describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage. METHODS: Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage >0.5 mV during high-density 3-dimensional mapping were studied. RESULTS: Sinus node exits varied among patients along a lateral oblique arc extending from the anterior aspect of the superior vena cava (SVC) to the mid-posterior wall of the right atrium (RA). Conduction slowing or block at one of the smooth components that faces the crista terminalis was observed in 54% of cases, including complete block at the SVC musculature and systemic venous sinus in 6% of cases. Depending on these 2 key features of RA activation, interatrial conduction was mediated by the Bachmann bundle (64%) and posterior bundles (54%), with an overlap of the resulting left atrial breakthrough location. Wavefront collision was consistently observed at 3 sites: the septal aspect of the cavotricuspid isthmus, and the lower aspects of the dome and of the mitral isthmus. CONCLUSION: During sinus rhythm, atrial activation occurs via distinct sequences mediated by a complex interaction of anatomic factors.      «

BACKGROUND: An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics. OBJECTIVE: The purpose of this study was to describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage. METHODS: Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage >0.5 mV during h...     »