Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation
Fiorenzo Gaita, MD*,
Leonardo Calò, MD*,
Riccardo Riccardi, MD*,
Lucia Garberoglio, MD*,
Marco Scaglione, MD*,
Giovanni Licciardello, MD*,
Luisella Coda, MD*,
Paolo Di Donna, MD*,
Mario Bocchiardo, MD*,
Domenico Caponi, MD*,
Renzo Antolini, PhD ,
Fulvio Orzan, MD and
GianPaolo Trevi, MD
* Division of Cardiology, Civil Hospital, Asti, Italy
INFM Department of Physics, University of Trento, Trento, Italy
Department of Internal Medicine/Cardiology, University of Torino, Torino, Italy
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Figure 1 Fluoroscopic views of catheters position. A Constellation catheter (EP Technologies) is positioned in the right atrium. Two decapolar catheters are placed in the CS and in the septal region of the left atrium. LAO = left anterior oblique view; RAO = right anterior oblique view.
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Figure 2 Examples of different patterns of AF. Left panel (A S): The atrial activation is regular in the lateral and posterior wall in the right atrium and in the CS, with a definite single electrogram. The activation sequence is clearly craniocaudal in the RL wall. The septal region, both right (especially mid and low) and left, shows disorganized atrial activity with double, fragmented electrograms. Middle left panel (B RP, S): Atrial activation is regular in the lateral wall, where a craniocaudal sequence is evident, and in the CS. In contrast, the RS, LS and RP wall show irregular atrial activation with fragmented, double and low amplitude atrial electrograms. Right middle panel (C CS, RP, S): The activation sequence is almost regular in the RL wall, with a craniocaudal sequence, whereas in the other sites (RP wall, septum and CS), fragmented and double electrograms are present. Right panel (D): All recording sites show very irregular, disorganized atrial activation. RAN = right anterior wall; RL = right lateral wall; RPL = right posterolateral wall; RP = right posterior wall; RPS = right posteroseptal wall; RS = right septum; RAS = right anteroseptal wall; LHS = left high septum; LMS = left mid septum; LLS = left low septum; DCS = distal coronary sinus; PCS = proximal coronary sinus; II = lead II electrocardiogram; S = septum (both right and left); LS = left septum. Each pair of electrodes of the basket catheter is identified by a number: 1 = most distal (superior); 4 = most proximal (inferior) on the spline. At the bottom of each panel, a 7-s electrocardiographic strip is shown; the space between the vertical lines corresponds to the endocavitary signals.
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Figure 3 Mapping results: FF interval durations. Data are expressed as the mean value. The differences at all sites were statistically significant (p < 0.05). CAF = chronic atrial fibrillation; CS = coronary sinus; LHS = left high septum; LLS = left low septum; PAF = paroxysmal atrial fibrillation; RAN = right anterior wall; RHL = right high lateral wall; RHP = right high posterior wall; RHS = right high septum; RLL = right low lateral wall; RLP = right low posterior wall; RLS = right low septum.
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Figure 4 Mapping results: Wells’ types. Data are expressed as the mean value. The graph shows the incidences of Wells’ types of AF. Abbreviations as in Figure 3. See text for discussion.
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Figure 5 Total duration (expressed as percentage) of the different directions of atrial activation and of the disorganized atrial activity in the five analyzed regions in patients with paroxysmal and chronic AF. CCr = caudocranial; CrC = craniocaudal; CS = coronary sinus; Dis = disorganized; Ind = indeterminable; LS = left septum; RL = right lateral wall; RP = right posterior wall; RS = right septum.
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Figure 6 Patterns of AF. Top, The percentage of each pattern of AF in chronic AF. Bottom, The percentage of each pattern of AF in paroxysmal AF. See text for discussion.
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Figure 7 Top, Paired columns represent the mean ERPs for drive cycle lengths of 600 ms and 400 ms at the 10 pacing atrial sites. Middle, The columns show the mean FF intervals at each pacing site where the ERP was determined. Bottom, Bar graph summarizes the mean duration (expressed as percentage) of the three different Wells’ types for each pacing site. Abbreviations as in Figure 3.
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