HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chang, B. C. Articles by Cox, J. L. Search for Related Content PubMed PubMed Citation Articles by Chang, B. C. Articles by Cox, J. L.

The Annals of Thoracic Surgery, Vol 49, 231-241, Copyright © 1990 by The Society of Thoracic Surgeons

ARTICLES

Computerized activation sequence mapping of the human atrial septum

BC Chang, RB Schuessler, CM Stone, BH Branham, TE Canavan, JP Boineau, ME Cain, PB Corr and JL Cox
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Missouri.

To delineate the propagation of electrical activation in the atrial septum, atrial epicardial and atrial septal maps were recorded intraoperatively using a 156-channel computerized mapping system in 12 patients during sinus rhythm (n = 10), supraventricular tachycardia associated with septal pathways in Wolff-Parkinson-White syndrome (n = 3), atrioventricular (AV) node reentrant tachycardia (n = 4), and atrial flutter (n = 5). The epicardial and septal data were recorded simultaneously from 156 atrial electrodes, digitized, analyzed, and displayed as isochronous maps on a two-dimensional diagram of the atria. During sinus rhythm, the activation wave fronts propagated most rapidly along the large muscle bundles of the atrial septum. During supraventricular tachycardia associated with Wolff-Parkinson-White syndrome, the earliest site of retrograde atrial activation usually corresponded to the position of atrial insertion of the septal pathways. However, the earliest site of activation during orthodromic supraventricular tachycardia was different from that during ventricular pacing in 1 patient with a posterior septal accessory pathway localized by the epicardial mapping study. The data document the rationale for dividing the ventricular end of the accessory pathways (ie, the endocardial technique) rather than the atrial end (ie, the epicardial technique) in patients with Wolff-Parkinson-White syndrome. During AV node reentrant tachycardia, atrial activation data suggested that atrial tissue lying outside the confines of the anatomical AV node is a necessary link in this common arrhythmia. Thus, these atrial septal maps explain why surgical dissection, or properly positioned small cryolesions placed in the region of the AV node, can ablate AV node reentrant tachycardia without altering normal AV node function. The maps recorded during atrial flutter suggest the importance of the atrial septum as one limb of a macroreentrant circuit responsible for the arrhythmia, and imply that atrial flutter is amenable to control by surgical techniques. These studies demonstrate the details of normal atrial septal activation, the importance of the atrial septum in a variety of different atrial arrhythmias, and the basis of and potential for surgical ablation of the most common types of supraventricular arrhythmias.

This article has been cited by other articles:

				R. Lemery, L. Soucie, B. Martin, A. S.L. Tang, M. Green, and J. Healey Human Study of Biatrial Electrical Coupling: Determinants of Endocardial Septal Activation and Conduction Over Interatrial Connections Circulation, October 12, 2004; 110(15): 2083 - 2089. [Abstract] [Full Text] [PDF]

				M. Fatemi, G. Kirkorian, P. Chevalier, P. Lavaud, C. Bellon, A. Da Costa, E. Bonnefoy, and P. Touboul Influence of atrial flutter ablation on right to left inter-atrial conduction Europace, January 1, 2001; 3(1): 64 - 72. [Abstract] [PDF]

				David M. Harrild, Craig S. Henriquez ; A Computer Model of Normal Conduction in the Human Atria Circ. Res., September 29, 2000; 87 (7): e25 - e36. [Abstract] [Full Text] [PDF]

				R.J Schilling, A.H Kadish, N.S Peters, J Goldberger, and D.W. Davies Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter Eur. Heart J., April 1, 2000; 21(7): 550 - 564. [Abstract] [PDF]

				T. Nitta, R. Lee, R. B. Schuessler, J. P. Boineau, and J. L. Cox Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure Ann. Thorac. Surg., January 1, 1999; 67(1): 27 - 35. [Abstract] [Full Text] [PDF]

				D. Medkour, A. E. Becker, K. Khalife, and J. Billette Anatomic and Functional Characteristics of a Slow Posterior AV Nodal Pathway : Role in Dual-Pathway Physiology and Reentry Circulation, July 14, 1998; 98(2): 164 - 174. [Abstract] [Full Text] [PDF]

				F. Amellal and J. Billette Selective Functional Properties of Dual Atrioventricular Nodal Inputs: Role in Nodal Conduction, Refractoriness, Summation, and Rate-Dependent Function in Rabbit Heart Circulation, August 15, 1996; 94(4): 824 - 832. [Abstract] [Full Text]

				T. Tabuchi, K. Okumura, T. Matsunaga, R. Tsunoda, M. Jougasaki, and H. Yasue Linear Ablation of the Isthmus Between the Inferior Vena Cava and Tricuspid Annulus for the Treatment of Atrial Flutter : A Study in the Canine Atrial Flutter Model Circulation, September 1, 1995; 92(5): 1312 - 1319. [Abstract] [Full Text]