Characterization of right atrial substrate in patients with supraventricular tachyarrhythmias.
Right atrial substrate of supraventricular tachyarrhythmias.


BACKGROUND
Voltage mapping has been used to detect diseased myocardium. However, accurate determination of the local atrial voltage at the same site, and simultaneous recordings from multiple mapping sites were limited. The purpose of this study was to investigate the right atrial (RA) substrate properties in patients with supraventricular tachyarrhythmias (SVT).


RESULTS
Forty patients (aged 55+/-20 years) undergoing noncontact mapping and ablation of SVT constituted the study population. There were eight patients with atrioventricular node reentrant tachycardia (AVNRT), eight patients with focal atrial tachycardia (AT), 14 patients with atrial flutter (AFL), and 10 patients with atrial fibrillation (AF). The mean peak negative voltage (PNV) was analyzed in virtual unipolar electrograms, which were obtained from 256 equally distributed RA endocardial sites during sinus rhythm (SR), atrial pacing, and tachycardia. The mean PNV of global RA during SR (-1.34+/-0.22 vs. -0.90+/-0.40 vs. -1.00+/-0.36 vs. -0.85+/-0.35 mV, P=0.04), atrial pacing at cycle lengths of 500 ms (-1.30+/-0.29 vs. -0.70+/-0.35 vs. -0.76+/-0.25 vs. -0.64+/-0.26 mV, P=0.02), and 300 ms (-1.54+/-0.47 vs. -0.94+/-0.21 vs. -0.75+/-0.27 vs. -0.57+/-0.22 mV, P<0.01) were significantly greater in patients with AVNRT compared to AT, AFL, and AF. Furthermore, the mean PNV decreased during atrial pacing with shorter pacing cycle length was demonstrated only in patients with AFL and AF.


CONCLUSIONS
Negative unipolar voltage analysis of global RA showed different RA substrate characteristics during various SVT. The substrate property of activation and cycle length-dependent voltage reduction may be related to the development of AFL and AF.
Lin
Yenn-Jiang
YJ
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Tai
Ching-Tai
CT
Huang
Jin-Long
JL
Lee
Kun-Tai
KT
Lee
Pi-Chang
PC
Hsieh
Ming-Hsiung
MH
Lee
Shih-Huang
SH
Higa
Satoshi
S
Yuniadi
Yoga
Y
Liu
Tu-Ying
TY
Chen
Shih-Ann
SA
D001281:Atrial Fibrillation / Q000503:physiopathology; D001282:Atrial Flutter / Q000503:physiopathology; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000503:physiopathology*