title: Electroanatomical mapping of the right atrium during atrial tachycardia originating from right superior pulmonary vein: additional insights on differential diagnosis.
abstract: BACKGROUND
  Atrial tachycardia (AT) from the right superior pulmonary vein (RSPV) may mimic right atrial (RA)-AT due to its proximity to the superior vena cava (SVC) and the preferential connections between the left atrium and right atrium.
  
  
  OBJECTIVE
  RA electroanatomical mapping was performed and analyzed during RSPV-AT to differentiate it from RA-AT.
  
  
  METHODS
  Electroanatomical mapping of the RA was performed in 16 consecutive patients with RSPV-AT and eight consecutive patients with SVC-AT served as control group.
  
  
  RESULTS
  RA mapping revealed single breakthrough in six patients and double breakthroughs in 10 patients in the RSPV-AT group. The initial 10-ms atrial depolarization area averaged 4.3 ± 1.5 cm(2). None of the SVC-ATs exhibited double breakthrough sites with an initial 10-ms atrial depolarization area of 2.0 ± 0.6 cm(2) (P = 0.001). A cutoff value of activation area of initial 10 ms > 3.15 cm(2) was able to predict RSPV-AT with a sensitivity of 87.5% and a specificity of 100%. Preceding far-field RSPV potentials could be documented in the RA in six patients during RSPV-AT.
  
  
  CONCLUSIONS
  During RSPV-AT, diffused initial depolarization and one or two separated breakthrough sites consistent with the preferential connections as revealed by RA mapping could help rule out RA-AT and avoid unnecessary ablation at the RA.
authors.affiliation: Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
authors.forename: De Yong
authors.initials: DY
authors.lastname: Long
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salim
authors.forename: Jian Zeng
authors.initials: JZ
authors.lastname: Dong
authors.forename: Cai Hua
authors.initials: CH
authors.lastname: Sang
authors.forename: Chen Xi
authors.initials: CX
authors.lastname: Jiang
authors.forename: Ri Bo
authors.initials: RB
authors.lastname: Tang
authors.forename: Song Nan
authors.initials: SN
authors.lastname: Li
authors.forename: Rong Hui
authors.initials: RH
authors.lastname: Yu
authors.forename: Yan
authors.initials: Y
authors.lastname: Yao
authors.forename: Man
authors.initials: M
authors.lastname: Ning
authors.forename: Chang
authors.initials: C
authors.lastname: Sheng
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011667:Pulmonary Veins; D013617:Tachycardia, Supraventricular / Q000175:diagnosis*
keywords: ablation; atrial tachycardia; mapping; right superior pulmonary vein