Abstract
PurposePrevious studies examined the right atrial (RA) input site of the antegrade fast pathway (AFp) (AFpI). However, the left atrial (LA) input to the atrioventricular (AV) node has not been extensively evaluated. In this study, we created three-dimensional (3-D) bi-atrial stimulus-ventricle (St-V) maps and analyzed the input site and characteristics of the AFp in both the RA and LA.MethodsForty-four patients diagnosed with atrial fibrillation or WPW syndrome were included in this study. Three-dimensional bi-atrial St-V mapping was performed using an electroanatomical mapping system. Sites exhibiting the minimal St-V interval (MinSt-V) were defined as AFpIs and were classified into seven segments, four in the RA (F, S, M, and I) and three in the LA (M1, M2, and M3). By combining the MinSt-V in the RA and LA, the AFpIs were classified into three types: RA, LA, and bi-atrial (BA) types. The clinical and electrophysiological characteristics were compared.ResultsAFpIs were most frequently observed at site S in the RA (34%) and M2 in the LA (50%), and the BA type was the most common (57%). AFpIs in the LA were recognized in 75% of the patients. There were no clinical or electrophysiological indicators for predicting AFpI sites.ConclusionsThree-dimensional bi-atrial St-V maps could classify AFpIs in both the RA and LA. AFpIs in the LA were frequently recognized. There were no significant clinical or electrophysiological indicators for predicting AFpI sites, and 3-D bi-atrial St-V mapping was the only method to reveal the precise AFp input site.
Highlights
The exit site of the retrograde fast pathway (RFp) from the atrioventricular node (AVN) can be determined by mapping the earliest activation site in the atrium during constant pacing from the ventricle
Class I drugs were used in 13 patients, class II in 7 patients, and class IV in 9 patients
An St-V map was used instead of the St-H map because a His catheter was not used in the majority of the patients who had atrial fibrillation (77%) and the St-V map was equivalent to the St-H map
Summary
The exit site of the retrograde fast pathway (RFp) from the atrioventricular node (AVN) can be determined by mapping the earliest activation site in the atrium during constant pacing from the ventricle. The input site of the antegrade fast pathway (AFp) to the AVN has been very difficult to determine and only stimulus-His (St-H) mapping can identify the input site of the AFp to the AVN (AFpI) [1,2,3,4,5]. We created 3-D bi-atrial stimulus-ventricle (St-V) maps, which were equivalent to St-H maps, and analyzed the input site and characteristics of the AFp in both the RA and LA
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