Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter
Koichiro Kumagai, MD, FACC*,*,
Masahiro Ogawa, MD*,
Hiroo Noguchi, MD*,
Tomoo Yasuda, MD*,
Hideko Nakashima, MD* and
Keijiro Saku, MD, FACC*
* Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
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Figure 1 Electrophysiologic measurements. Proximal (bipoles 7–8) electrograms from all splines of the basket catheter placed in the left superior pulmonary vein are shown. The drive cycle conduction time (S1–A1) and the conduction time of the shortest coupled extrastimulus propagated to the site (S2–A2) are measured, and the minimum and maximum values among all the splines are determined. Letters A to H identify basket splines.
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Figure 2 Detection of the exit breakthrough points by pulmonary vein (PV) distal pacing. Proximal (bipoles 7–8) electrograms from all splines of the basket catheter placed in the left superior pulmonary vein are shown. Of all PV distal pacing sites, four (B, D, F, and H) are shown. During pacing from B1–2, the earliest activation sites (*) are A7–8 and D7–8. During pacing from D and F1–2, the earliest activation site (*) is D7–8. During pacing from H1–2, the earliest activation site (*) is A7–8. Thus, the exit breakthrough points are A7–8 and D7–8. In contrast, during coronary sinus distal (CS d) pacing, the entrance breakthrough point (*) is A7–8.
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Figure 3 Detection of the exit breakthrough points in the right superior pulmonary vein (RSPV) by pulmonary vein (PV) distal pacing. Proximal (bipoles 7–8) electrograms from all splines of the basket catheter placed in the RSPV are shown. (Left panel) During sinus rhythm, atrial (A) and PV potentials approach each other. (Right panel) During PV distal pacing from A 1–2, these potentials are discriminated. The exit breakthrough point (*) is B 7–8.
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Figure 4 Activation maps of the left superior pulmonary vein during pulmonary vein (PV) distal pacing and during coronary sinus (CS) distal pacing from a representative episode. Letters A to H identify basket splines. An anatomic grid is shown in an apical view, with the distal electrodes in the center and proximal electrodes on the periphery. Lines with arrows indicate activation wave fronts. Thin lines represent isochrones at 10-ms intervals. (Left map) During PV distal pacing from bipoles A 1–2 (star), the earliest activation site around the PV-left atrium junction (i.e., the exit breakthrough point) is B 7–8. (Right map) During CS distal pacing, the entrance breakthrough point is A or H 7–8.
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Figure 5 Analysis of consecutive activation patterns during a representative episode of initiation of atrial fibrillation (AF) induced by extrastimulation from A 1–2. (A) Pulmonary vein recordings from a basket catheter placed in the left superior pulmonary vein from the same patient as shown in Figure 4. After extrastimulus S2 of 200 ms, AF is induced. The numbers identify the conduction times from S2. a = far-field atrial potential. (B) A total of 600 ms of data (six consecutive time windows) from an initiation of the episode is analyzed. The star indicates the pacing site (A 1–2). Dark gray regions indicate areas that were not activated during a 100-ms window. The dashed line indicates a line of functional block. In this case, a re-entrant circuit involving the exit breakthrough point (splines B and C) and the entrance breakthrough point (spline H) starts AF. Wave fronts traveling to and from the left atrium may play an important role in reformation of activation. However, no re-entrant circuits only within the pulmonary vein are observed.
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Figure 6 Analysis of consecutive activation patterns during a representative episode of spontaneous onset of atrial fibrillation (AF). (A) Pulmonary vein recordings from a basket catheter placed in the right superior pulmonary vein during an episode of spontaneous onset of AF from F 5–6. The numbers identify the conduction times from the earliest activation potential. (B) In this case, rapid, repetitive firings induce the pulmonary vein (PV)-left atrium (LA) conduction block and PV-LA reciprocating re-entrant circuit involving the exit breakthrough point (splines A and B), and the entrance breakthrough point (spline F) is created. Also, a re-entrant circuit lasting for 1.5 rotations, with a cycle length of 100 ms, is observed within the PV.
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