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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDER: CLINICAL RESEARCH: SUPRAVENTRICULAR TACHYCARDIAS

Atrial Tachycardia Arising Adjacent to Noncoronary Aortic Sinus

Distinctive Atrial Activation Patterns and Anatomic Insights

Xingpeng Liu, MD^_*,, Jianzeng Dong, MD^_*, Siew Yen Ho, PhD, Ashok Shah, MD, Deyong Long, MD^_*, Ronghui Yu, MD^_*, Ribo Tang, MD^_*, Meleze Hocini, MD, Michel Haissaguerre, MD and Changsheng Ma, MD^_*,_*

^_* Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Hopital Cardologique du Haut-Leveque and the Universite Bordeaux II, Bordeaux, France
Cardiac Morphology Unit, National Heart & Lung Institute, Imperial College London, London, United Kingdom

Manuscript received December 9, 2009; revised manuscript received February 26, 2010, accepted March 30, 2010.

^_* Reprints requests and correspondence: Dr. Changsheng Ma, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China (Email: chshma{at}vip.sina.com).

Objectives: We sought to determine whether atrial tachycardia arising adjacent to the noncoronary aortic sinus (NCAS-AT) has distinctive atrial activation patterns in relation to targeted anatomic imaging.

Background: The knowledge of atrial activation patterns of the NCAS-AT and its anatomic basis is very limited.

Methods: Three-dimensional electroanatomic mapping was performed during NCAS-AT in 13 patients and during sequentially pacing from the noncoronary aortic sinus (NCAS) and the para-Hisian atrial area in 15 reference patients. The spatial relationship between the NCAS and the contiguous atria was studied in another 25 reference patients using computed tomography and in 12 human hearts using gross and microscopic anatomic examination.

Results: During NCAS-AT, the para-Hisian area of the right atrium (RA) and the anteroseptal region of the left atrium were activated almost simultaneously. The initial activation area (within first 20 ms of atrial depolarization) was relatively wide (9.3 ± 2.6 cm² on the RA map and 8.1 ± 2.1 cm² on the left atrium map). In reference patients, NCAS pacing reproduced a biatrial activation pattern of NCAS-AT and resulted in a wider initial activation area than the para-Hisian atrial pacing within first 20 ms of RA activation (10.1 ± 3.0 cm² vs. 3.9±1.7 cm²; p < 0.001). Anatomically, the wall of NCAS did not contain myocardial tissue, but was intimately related to the paraseptal regions of the atria such that the shortest distances from the NCAS to the RA and the left atrium were 1.7 ± 0.6 mm and 2.3 ± 0.9 mm (p < 0.01), respectively.

Conclusions: NCAS-AT has distinct atrial activation patterns that can be explained in part by its spatial anatomic relationship with the atria.

Key Words: activation pattern • anatomy • atrial tachycardia • noncoronary aortic sinus • 3-dimensional mapping

Abbreviations and Acronyms   3D = 3-dimensional   AT = atrial tachycardia   CS = coronary sinus   CT = computed tomography   LA = left atrium   NACS = noncoronary aortic sinus   RA = right atrium

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J. Am. Coll. Cardiol. 2010 56: A22. [Full Text] [PDF]

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