Simple and accurate catheter mapping technique to predict atrial fibrillation foci in the pulmonary veins or posterior right atrium.
OBJECTIVE
The purpose of this study was to investigate the efficacy of a novel catheter mapping technique for predicting atrial fibrillation (AF) foci.


BACKGROUND
Most AF originates from pulmonary veins (PVs), but some originate from the right atrium.


METHODS
We developed an algorithm by correlating the cardiac recordings obtained from multielectrode catheters placed in the posterior right atrium (RA) and esophagus during pacing from the PVs and superior vena cava (SVC) or crista terminalis (CT) in 10 AF patients. We tested the algorithm's accuracy prospectively in 46 AF patients.


RESULTS
During pacing from the left PVs, the esophageal potentials preceded all other potentials. During pacing from both the right PVs and SVC-CT, the first component (FP) of the double potential (DP) recorded in the posterior RA preceded all other potentials. The amplitude of the FP was higher than that of the second DP component during pacing from the SVC-CT, whereas the reverse occurred from the right PVs. The activation sequence of the FPs and esophageal potentials was from superior to inferior during pacing from the superior PVs, whereas the reverse occurred from the inferior PVs. The accuracy of predicting 34 foci in the right PVs, 28 foci in left PVs, and 6 foci in SVC-CT was 100% for all, respectively. The accuracy of discriminating foci in the superior PVs from those in the inferior PVs was 97% in the right PVs and 96% in the left PVs.


CONCLUSIONS
The technique using mapping catheters placed in the posterior RA and esophagus is feasible and effective for mapping and ablating AF.
Yamada
Takumi
T
Division of Cardiology, Aichi Prefectural Owari Hospital, Cardiovascular Center, Ichinomiya, Japan. takumi-y@fb4.so-net.ne.jp
Murakami
Yoshimasa
Y
Muto
Masahiro
M
Okada
Taro
T
Okamoto
Mitsuhiro
M
Shimizu
Takeshi
T
Toyama
Junji
J
Yoshida
Yukihiko
Y
Tsuboi
Naoya
N
Ito
Teruo
T
Kondo
Takahisa
T
Inden
Yasuya
Y
Hirai
Makoto
M
Murohara
Toyoaki
T
D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology*