Electroanatomical Mapping of the Right Atrium during Atrial Tachycardia Originating from Right Superior Pulmonary Vein: Additional Insights on Differential Diagnosis.

DIFFERENTIAL diagnosis; BODY surface mapping; TACHYCARDIA diagnosis; HEART atrium; ELECTROPHYSIOLOGY methodology; CHI-squared test; FISHER exact test; PULMONARY veins; RESEARCH funding; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; RIGHT heart atrium; DIAGNOSIS

Background Atrial tachycardia (AT) from the right superior pulmonary vein (RSPV) may mimic right atrial (RA)-AT due to its proximity to the superior vena cava (SVC) and the preferential connections between the left atrium and right atrium. Objective RA electroanatomical mapping was performed and analyzed during RSPV-AT to differentiate it from RA-AT. Methods Electroanatomical mapping of the RA was performed in 16 consecutive patients with RSPV-AT and eight consecutive patients with SVC-AT served as control group. Results RA mapping revealed single breakthrough in six patients and double breakthroughs in 10 patients in the RSPV-AT group. The initial 10-ms atrial depolarization area averaged 4.3 ± 1.5 cm2. None of the SVC-ATs exhibited double breakthrough sites with an initial 10-ms atrial depolarization area of 2.0 ± 0.6 cm2 (P = 0.001). A cutoff value of activation area of initial 10 ms > 3.15 cm2 was able to predict RSPV-AT with a sensitivity of 87.5% and a specificity of 100%. Preceding far-field RSPV potentials could be documented in the RA in six patients during RSPV-AT. Conclusions During RSPV-AT, diffused initial depolarization and one or two separated breakthrough sites consistent with the preferential connections as revealed by RA mapping could help rule out RA-AT and avoid unnecessary ablation at the RA. [ABSTRACT FROM AUTHOR]