High-density mapping of the sinus node in humans: role of preferential pathways and the effect of remodeling

Journal of Cardiovascular Electrophysiology
Martin K StilesPrashanthan Sanders

Abstract

The area of the functional sinus node complex exceeds that of the anatomical sinus node; however, reasons for this discrepancy are unknown. We aimed to characterize the functional sinus node complex in health and disease with high-density simultaneous mapping. Sinus node activity was characterized in 15 reference patients after ablation for supraventricular tachycardia. A further 16 patients were studied following ablation of chronic atrial flutter to determine effects of atrial remodeling. High-density simultaneous mapping of the sinus node complex was performed using a multi-electrode array. In reference patients, distance from superior vena cava-right atrial (SVC-RA) junction to earliest activation (EA) was 4 +/- 4 mm and sinus break-out (SBO) 9 +/- 6 mm. Preferential pathways of conduction were observed between EA and SBO. For patients with flutter, these distances were greater (EA: 15 +/- 12 mm, P = 0.003; SBO: 23 +/- 11 mm, P < 0.001). Conduction time along preferential pathways was 15 +/- 5 ms for reference patients and 23 +/- 8 ms for patients with flutter (P = 0.005). Following pacing, distance from SVC-RA junction to EA and SBO lengthened to 13 +/- 8 mm (P = 0.006) and 16 +/- 10 mm (P = 0.02), respectively, in referen...Continue Reading

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Citations

Jul 10, 2012·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Hung-Yu ChangShih-Ann Chen
Aug 22, 2012·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Justin M S Lee, Jonathan M Kalman
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Oct 29, 2014·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Andreas BollmannGerhard Hindricks
Jun 8, 2018·Circulation Journal : Official Journal of the Japanese Circulation Society·Yasuaki TanakaKenzo Hirao
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Jan 30, 2021·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·G GarretN Saoudi
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Aug 3, 2021·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Dhanunjaya LakkireddyRakesh Gopinathannair
Jan 1, 2011·Current Opinion in Cardiology

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