TY - JOUR
T1 - Simultaneous epicardial–endocardial mapping of the sinus node in humans with structural heart disease
T2 - Impact of overdrive suppression on sinoatrial exits
AU - Parameswaran, Ramanathan
AU - Lee, Geoffrey
AU - Morris, Gwilym M.
AU - Royse, Alistair
AU - Goldblatt, John
AU - Larobina, Marco
AU - Watts, Troy
AU - Nalliah, Chrishan J.
AU - Wong, Geoffrey
AU - Al-Kaisey, Ahmed M.
AU - Anderson, Robert D.
AU - Voskoboinik, Aleksandr
AU - Sugumar, Hariharan
AU - Chieng, David
AU - Sanders, Prashanthan
AU - Kistler, Peter M.
AU - Kalman, Jonathan M.
N1 - Funding Information:
Funding sources/Disclosures: Drs Parameswaran, Nalliah, Wong, Anderson, Voskoboinik, Sugumar, and Chieng are supported by the National Health and Medical Research Council (NHMRC) research scholarship. Drs Kalman and Sanders are supported by practitioner fellowships from the NHMRC. Dr Morris is supported by a British Heart Foundation Intermediate Fellowship; has reported receiving research support from Boston Scientific and Medtronic; and has served on the advisory board of Boston Scientific and Biosense Webster. Dr Kalman has reported receiving research support from Biosense Webster, Boston Scientific, Abbott, and Medtronic; and has served on the advisory board of Boston Scientific and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Funding sources/Disclosures: Drs Parameswaran, Nalliah, Wong, Anderson, Voskoboinik, Sugumar, and Chieng are supported by the National Health and Medical Research Council ( NHMRC ) research scholarship. Drs Kalman and Sanders are supported by practitioner fellowships from the NHMRC . Dr Morris is supported by a British Heart Foundation Intermediate Fellowship; has reported receiving research support from Boston Scientific and Medtronic; and has served on the advisory board of Boston Scientific and Biosense Webster . Dr Kalman has reported receiving research support from Biosense Webster , Boston Scientific , Abbott , and Medtronic; and has served on the advisory board of Boston Scientific and Biosense Webster . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 Heart Rhythm Society
PY - 2020/12
Y1 - 2020/12
N2 - Background: The 3-dimensional (3D) nature of sinoatrial node (SAN) function has not been characterized in the intact human heart. Objective: The purpose of this study was to characterize the 3D nature of SAN function in patients with structural heart disease (SHD) using simultaneous endocardial–epicardial (endo–epi) phase mapping. Methods: Simultaneous intraoperative endo–epi SAN mapping was performed during sinus rhythm at baseline (SRbaseline) and postoverdrive suppression at 600 ms (SRpost-pace600) and 400 ms (SRpost-pace400) using 2 Abbott Advisor HD Grid Mapping Catheters. Unipolar and bipolar electrograms (EGMs) were exported for phase analysis to determine (1) activation exits; (2) wavefront propagation sequence; (3) endo–epi dissociation; and (4) fractionation. Comparison of these variables was made among the 3 rhythms from an endo–epi perspective. Results: Sixteen patients with SHD were included. SRbaseline activations were unicentric and predominantly exited cranially (87.5%) with endo–epi synchrony. However, with overdrive suppression, a tendency for caudal exit shift and endo–epi asynchrony was observed: SRpost-pace600 vs SRbaseline: cranial endo 75% vs 87.5% (P = .046); cranial epi 68.8% vs 87.5% (P = 0.002); caudal endo 12.5% vs 6.2% (P = 0.215); caudal epi 25% vs 6.2% (P = .0003); and SRpost-pace400 vs SRbaseline: cranial endo 81.3% vs 87.5% (P = 0.335); cranial epi 68.7% vs 87.5% (P = 0.0034; caudal endo 12.5% vs 6.2% (P = .148); caudal epi 31.2% vs 6.2% (P = 0.0017), consistent with multicentricity. EGM fractionation was more prevalent with overdrive suppression. Conclusion: During mapping of the intact human heart, SAN demonstrated redundancy of sinoatrial exits with postoverdrive shift in sites of earliest activation and epi–endo dissociation of sinoatrial exits.
AB - Background: The 3-dimensional (3D) nature of sinoatrial node (SAN) function has not been characterized in the intact human heart. Objective: The purpose of this study was to characterize the 3D nature of SAN function in patients with structural heart disease (SHD) using simultaneous endocardial–epicardial (endo–epi) phase mapping. Methods: Simultaneous intraoperative endo–epi SAN mapping was performed during sinus rhythm at baseline (SRbaseline) and postoverdrive suppression at 600 ms (SRpost-pace600) and 400 ms (SRpost-pace400) using 2 Abbott Advisor HD Grid Mapping Catheters. Unipolar and bipolar electrograms (EGMs) were exported for phase analysis to determine (1) activation exits; (2) wavefront propagation sequence; (3) endo–epi dissociation; and (4) fractionation. Comparison of these variables was made among the 3 rhythms from an endo–epi perspective. Results: Sixteen patients with SHD were included. SRbaseline activations were unicentric and predominantly exited cranially (87.5%) with endo–epi synchrony. However, with overdrive suppression, a tendency for caudal exit shift and endo–epi asynchrony was observed: SRpost-pace600 vs SRbaseline: cranial endo 75% vs 87.5% (P = .046); cranial epi 68.8% vs 87.5% (P = 0.002); caudal endo 12.5% vs 6.2% (P = 0.215); caudal epi 25% vs 6.2% (P = .0003); and SRpost-pace400 vs SRbaseline: cranial endo 81.3% vs 87.5% (P = 0.335); cranial epi 68.7% vs 87.5% (P = 0.0034; caudal endo 12.5% vs 6.2% (P = .148); caudal epi 31.2% vs 6.2% (P = 0.0017), consistent with multicentricity. EGM fractionation was more prevalent with overdrive suppression. Conclusion: During mapping of the intact human heart, SAN demonstrated redundancy of sinoatrial exits with postoverdrive shift in sites of earliest activation and epi–endo dissociation of sinoatrial exits.
KW - Endocardial–epicardial mapping
KW - Exits
KW - Overdrive suppression
KW - Sinoatrial
KW - Sinus node
UR - http://www.scopus.com/inward/record.url?scp=85096174476&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2020.06.034
DO - 10.1016/j.hrthm.2020.06.034
M3 - Article
C2 - 32622994
AN - SCOPUS:85096174476
SN - 1547-5271
VL - 17
SP - 2154
EP - 2163
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -
