Atrial Activation Mapping in Sinus Rhythm in the Clinical Electrophysiology Laboratory: Observations During Bachmann's Bundle Block.

BUNDLE-branch block; CORONARY arteries; ELECTROPHYSIOLOGY; ARRHYTHMIA; HEART block; PATIENTS; NEUROLOGY

Introduction: The high posterolateral right atrium (RA) is considered the "sinus node area," but we tack information on endocardial atrial activation in sinus rhythm. We studied RA and left atrial (LA) endocardial activation in the etectrophysiology laboratory. Methods and Results: Thirty-five patients (21 men) aged 47 ± 16.4 years (mean ± SD) underwent RA mapping (22.2 ± 3.8 points). In 21 patients, LA activation was mapped (11.1 ± 3.9 points) through the coronary sinus (CS), right pulmonary artery, and/or a patent oval foramen. Fourteen patients had atrial arrhythmias, and 3 an ECG pattern of Bachmann's bundle block. Endocardial ILk activation preceded P wave in 5 (-14 ± 4.2 ms), coincided in 11, and followed P onset in 18 (16.7 ± 6.6 ms). Location of the zero point varied from the superior vena cava to the tow RA and from lateral to paraseptal ILk. In 19 patients, activation started simultaneously in 2 to 5 points located > 1 cm apart. RA activation was descending in most, but in 3 with low onset there was collision in the anterior and septal walls. In 15 of 21 patients, descending LA activation dominated, ending in the mid CS in 12, proximal CS in 1, and simultaneously throughout the CS in 2. In 3 with Bachmann's bundle block, CS activation was ascending and in 2 double potentials were recorded from the LA roof. Conclusion: During stable sinus rhythm, LA activation can start in different areas or simultaneously over large areas resulting in different activation patterns, both in the LA and the LA. LA activation is predominantly descending, but in Bachmann's bundle block it becomes ascending, and double potentials suggest a location of block in the LA roof. [ABSTRACT FROM AUTHOR]