Generic placeholder image

Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Mapping Strategies in Focal Atrial Tachycardias Demonstrating Early Septal Activation: Distinguishing Left From Right

Author(s): Vassil B. Traykov

Volume 11, Issue 2, 2015

Page: [111 - 117] Pages: 7

DOI: 10.2174/1573403X10666141013121428

Price: $65

Abstract

Determining the chamber of origin of focal atrial tachycardias (FATs) arising at or close to the septum might require biatrial mapping. This review focuses on the available tools and methods used to distinguish right atrial from left atrial origin before left atrial access is obtained. These include analysis of P wave morphology, assessing the timing of right atrial septal activation, the sequence of right atrial and/or biatrial activation and analysis of earliest electrogram morphology. The electroanatomical properties of the interatrial septum and coronary sinus that provide the basis for the above mentioned tools have also been briefly described.

Keywords: Focal atrial tachycardias, septal, electrogram analysis, coronary sinus musculature, biatrial mapping.

Graphical Abstract

[1]
Kalman JM, Olgin JE, Karch MR, Hamdan M, Lee RJ, Lesh MD. “Cristal tachycardias”: origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol 1998; 31(2): 451-9.
[2]
Kistler PM, Fynn SP, Haqqani H, et al. Focal atrial tachycardia from the ostium of the coronary sinus: electrocardiographic and electrophysiological characterization and radiofrequency ablation. J Am Coll Cardiol 2005; 45(9): 1488-93.
[3]
Morton JB, Sanders P, Das A, Vohra JK, Sparks PB, Kalman JM. Focal atrial tachycardia arising from the tricuspid annulus: electrophysiologic and electrocardiographic characteristics. J Cardiovasc Electrophysiol 2001; 12(6): 653-9.
[4]
Frey B, Kreiner G, Gwechenberger M, Gössinger HD. Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: significance of mapping both sides of the interatrial septum. J Am Coll Cardiol 38(2): 394-400.
[5]
Iwai S, Badhwar N, Markowitz SM, et al. Electrophysiologic properties of para-Hisian atrial tachycardia. Heart Rhythm 2011; 8(8): 1245-53.
[6]
Badhwar N, Kalman JM, Sparks PB, et al. Atrial tachycardia arising from the coronary sinus musculature: electrophysiological characteristics and long-term outcomes of radiofrequency ablation. J Am Coll Cardiol 2005; 46(10): 1921-30.
[7]
Kistler PM, Sanders P, Fynn SP, et al. Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: acute and long-term outcomes of radiofrequency ablation. Circulation 2003; 108(16): 1968-75.
[8]
Kistler PM, Sanders P, Hussin A, et al. Focal atrial tachycardia arising from the mitral annulus: electrocardiographic and electrophysiologic characterization. J Am Coll Cardiol 2003; 41(12): 2212-9.
[9]
Marrouche NF. SippensGroenewegen A, Yang Y, Dibs S, Scheinman MM. Clinical and electrophysiologic characteristics of left septal atrial tachycardia. J Am Coll Cardiol 2002; 40(6): 1133-9.
[10]
Yang Q, Ma J, Zhang S, Hu JQ, Liao ZL. Focal atrial tachycardia originating from the distal portion of the left atrial appendage: characteristics and long-term outcomes of radiofrequency ablation. Europace 2012; 14(2): 254-60.
[11]
Zhang T, Li XB, Wang YL, et al. Focal atrial tachycardia arising from the right atrial appendage: electrophysiologic and electrocardiographic characteristics and catheter ablation. Int J Clin Pract 2009; 63(3): 417-24.
[12]
Das S, Neuzil P, Albert CM, et al. Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve. J Cardiovasc Electrophysiol 2008; 19(3): 231-7.
[13]
Ouyang F, Ma J, Ho SY, et al. Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation. J Am Coll Cardiol 2006; 48(1): 122-31.
[14]
Anderson RH, Brown NA, Webb S. Development and structure of the atrial septum. Heart 2002; 88(1): 104-10.
[15]
Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1999; 10(11): 1525-33.
[16]
Ho SY, Sanchez-Quintana D. The importance of atrial structure and fibers. Clin Anat 2009; 22(1): 52-63.
[17]
Sun H, Velipasaoglu EO, Wu DE, et al. Simultaneous multisite mapping of the right and the left atrial septum in the canine intact beating heart. Circulation 1999; 100(3): 312-9.
[18]
Calo L, Lamberti F, Loricchio ML, et al. Transseptal activation during left atrial pacing in humans: electroanatomic mapping using a noncontact catheter and the intracardiac echocardiography. J Interv Card Electrophysiol 2002; 6(2): 149-59.
[19]
Lemery R, Soucie L, Martin B, Tang AS, Green M, Healey J. Human study of biatrial electrical coupling: determinants of endocardial septal activation and conduction over interatrial connections. Circulation 2004; 110(15): 2083-9.
[20]
Roithinger FX, Cheng J. SippensGroenewegen A, et al Use of electroanatomic mapping to delineate transseptal atrial conduction in humans. Circulation 1999; 100(17): 1791-7.
[21]
Ho SY, Anderson RH, Sanchez-Quintana D. Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res 2002; 54(2): 325-36.
[22]
Platonov PG, Mitrofanova L, Ivanov V, Ho SY. Substrates for intra-atrial and interatrial conduction in the atrial septum: anatomical study on 84 human hearts. Heart Rhythm 2008; 5(8): 1189-95.
[23]
Chauvin M, Shah DC, Haissaguerre M, Marcellin L, Brechenmacher C. The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation 2000; 101(6): 647-52.
[24]
Traykov VB, Pap R, Shalganov TN, et al. Electrogram analysis at the His bundle region and the proximal coronary sinus as a tool to predict left atrial origin of focal atrial tachycardias. Europace 2011; 13(7): 1022-7.
[25]
Lüdinghausen M, Ohmachi N, Boot C. Myocardial coverage of the coronary sinus and related veins. Clin Anat 1992; 5(1): 1-15.
[26]
Antz M, Otomo K, Arruda M, et al. Electrical conduction between the right atrium and the left atrium via the musculature of the coronary sinus. Circulation 1998; 98(17): 1790-5.
[27]
Tang CW, Scheinman MM, Van Hare GF, et al. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol 1995; 26(5): 1315-24.
[28]
Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol 2006; 48(5): 1010-7.
[29]
Qian ZY, Hou XF, Xu DJ, et al. An algorithm to predict the site of origin of focal atrial tachycardia. Pacing Clin Electrophysiol 201; 34(4): 414-21.
[30]
Wong MC, Kalman JM, Ling LH, et al. Left septal atrial tachycardias: electrocardiographic and electrophysiologic characterization of a paraseptal focus. J Cardiovasc Electrophysiol 2013; 24(4): 413-8.
[31]
Man KC, Chan KK, Kovack P, et al. Spatial resolution of atrial pace mapping as determined by unipolar atrial pacing at adjacent sites. Circulation 1996; 94(6): 1357-63.
[32]
Lee SH, Tai CT, Lin WS, et al. Predicting the arrhythmogenic foci of atrial fibrillation before atrial transseptal procedure: implication for catheter ablation. J Cardiovasc Electrophysiol 2000; 11(7): 750-7.
[33]
Chang KC, Chen JY, Lin YC, Huang SK. Usefulness of interatrial conduction time to distinguish between focal atrial tachyarrhythmias originating from the superior vena cava and the right superior pulmonary vein. J Cardiovasc Electrophysiol 2008; 19(12): 1231-5.
[34]
Wetzel U, Hindricks G, Schirdewahn P, et al. A stepwise mapping approach for localization and ablation of ectopic right, left, and septal atrial foci using electroanatomic mapping. Eur Heart J 2002; 23(17): 1387-93.
[35]
Schwartzman D. Right pulmonary vein potentials recorded from the posterior right atrial endocardium: human case report and validation in a porcine model. J Cardiovasc Electrophysiol 2000; 11(3): 330-3.
[36]
Soejima K, Stevenson WG, Delacretaz E, Brunckhorst CB, Maisel WH, Friedman PL. Identification of left atrial origin of ectopic tachycardia during right atrial mapping: analysis of double potentials at the posteromedial right atrium. J Cardiovasc Electrophysiol 2000; 11(9): 975-80.
[37]
Yamada T, Murakami Y, Muto M, et al. Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium. J Cardiovasc Electrophysiol 2004; 15(7): 745-51.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy