title: Transseptal activation during left atrial pacing in humans: electroanatomic mapping using a noncontact catheter and the intracardiac echocardiography.
abstract: BACKGROUND
  A better understanding of transseptal activation may be important for the treatment of atrial fibrillation, but little is known about preferential routes of conduction from the left atrium (LA) to the right atrium (RA) in humans.
  
  
  RESULTS
  Twelve patients were studied. A noncontact mapping system was used to map the RA during pacing from several sites of LA at different cycle lengths. The location of the Bachmann's bundle (BB), the fossa ovalis (FO) and the coronary sinus (CS) ostium were determined using intracardiac echocardiography. The BB was the earliest area of right atrial activation during pacing from the atrial appendage, roof and postero-superior wall in 94% of cases. The FO was the area of earliest activation during pacing from the septum and the right superior pulmonary veins (PV) in 95% of cases. The CS ostium (alone or associated with the FO) was the region of transseptal breakthrough in all patients during pacing from the right inferior PV, postero-inferior wall and distal CS. Various patterns of activation with 2 or 3 distinct areas of transseptal breakthrough were observed during pacing from the lateral wall and the left superior PV. The pacing cycle length did not influence the modality of transseptal activation.
  
  
  CONCLUSIONS
  Different patterns of transseptal activation were found during pacing from LA. The preferential routes of conduction from the LA to the RA were related to the sites of stimulation and were not influenced by the pacing cycle length.
authors: Department of Cardiac Diseases, San Filippo Neri Hospital, Rome, Italy. leonardo.calo@tin.it
authors: Leonardo
authors: L
authors: Calò
authors: Filippo
authors: F
authors: Lamberti
authors: Maria Luisa
authors: ML
authors: Loricchio
authors: Antonio
authors: A
authors: Castro
authors: Augusto
authors: A
authors: Boggi
authors: Furio
authors: F
authors: Colivicchi
authors: Claudio
authors: C
authors: Pandozi
authors: Massimo
authors: M
authors: Santini
mesh_terms: D000328:Adult; D018780:Body Surface Potential Mapping; D002304:Cardiac Pacing, Artificial; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged