Human study of biatrial electrical coupling: determinants of endocardial septal activation and conduction over interatrial connections.
BACKGROUND
The relative contribution of the atrial septum and interatrial connections to biatrial activation is a fundamental concept of human cardiac electrophysiology that has yet to be fully characterized. The purpose of the present study was to determine how both atria are coupled electrically.


RESULTS
Twenty patients (16 men; mean age 54+/-11years) with a history of symptomatic atrial fibrillation (AF) underwent simultaneous biatrial noncontact mapping before catheter ablation of AF. The multiple electrode array catheters were positioned, respectively, in the left atrium (LA; transseptally) and the right atrium (RA). In all but 2 patients, isopotential maps revealed that endocardial septal activations of the RA and LA were separate, independent, and asynchronous of each other. Interatrial conduction was related to the site of initial atrial depolarization, revealing conduction over Bachmann's bundle in all patients during sinus rhythm, high RA pacing, and pacing from the LA appendage. Pacing from the coronary sinus was associated with conduction over the interatrial connection at the level of the coronary sinus in all patients, and conduction over Bachmann's bundle also occurred in 5 (26%) of 19 patients. Interatrial conduction over the fossa ovalis occurred in only 2 (2%) of the 116 segments analyzed.


CONCLUSIONS
Electrical coupling of the RA and LA in humans is predominantly provided by muscular connections at the level of Bachmann's bundle and the coronary sinus. The true septum (the fossa ovalis and its limbus) of the RA and LA is asynchronous and discordant, usually without contralateral conduction during sinus rhythm or atrial pacing.
Lemery
Robert
R
Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7. rlemery@ottawaheart.ca
Soucie
Luc
L
Martin
Bruno
B
Tang
Anthony S L
AS
Green
Martin
M
Healey
Jeff
J
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000494:pharmacology; D020517:Atrial Appendage / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D004594:Electrophysiology / Q000379:methods; D004699:Endocardium / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006346:Heart Septum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
D000638:Amiodarone