Conduction characteristics in the left atrium of patients with perimitral atrial tachycardia post–pulmonary vein isolation

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-05-01 DOI:10.1016/j.hroo.2025.02.003

Mitsuru Takami MD, PhD , Ryudo Fujiwara MD, PhD , Atsushi Suzuki MD, PhD , Kunihiko Kiuchi MD, PhD , Kimitake Imamura MD, PhD , Kenichi Tani MD , Hidehiro Iwai MD , Yusuke Nakanishi MD , Mitsuhiko Shoda MD , Atsushi Murakami MD , Shogo Yonehara MD , Mari Yamamoto MD , Hiroyuki Asada MD , Takahiro Kunigita MD , Ryosuke Takahashi MD , Hiromasa Otake MD, PhD , Junya Shite MD, PhD , Koji Fukuzawa MD, PhD

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Abstract

Background

The electrical conduction properties of the left atrium (LA) in patients with perimitral atrial tachycardia (PMAT) after pulmonary vein isolation (PVI) are not completely understood.

Objectives

The purpose of this study was to investigate the characteristics of the segmental conduction velocity (CV) in the LA using multisite pacing in patients with PMAT.

Methods

After PVI in 179 patients, LA anterograde and retrograde propagation maps were created via pacing at different sites. Segmental CVs were measured in 7 distinct segments of the LA in both maps. Burst pacing was performed to induce atrial tachyarrhythmias.

Results

Twelve PMATs (7 clockwise rotation, 5 counterclockwise rotation) were induced in 11 patients (PMAT group), whereas no atrial tachyarrhythmias were induced in 56 (no induction group). Comparing the segmental CVs between the PMAT and no induction groups, we observed significant reductions in the PMAT group CVs, not only in the anterior and septal regions but also in the roof and bottom regions. Direction-dependent conduction delays were also observed in regions without or with small low-voltage areas, especially in the LA septum, lateral, and bottom. In the PMAT group, the very slow conduction area during PMAT consistently matched the region of the most reduced CV during either anterograde or retrograde propagation. Additionally, the direction of greater conduction delays in the anterior LA identified during pacing studies matched the direction of the PMAT rotation in 9 of 11 patients.

Conclusion

Patients with PMAT showed distinct segmental CVs in the LA, which may influence the tachycardia circuit formation and rotational direction.

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肺静脉隔离后围膜性房性心动过速患者左心房传导特征

背景肺静脉隔离（PVI）后围膜性房性心动过速（PMAT）患者左心房（LA）的电传导特性尚不完全清楚。目的探讨多位点起搏对PMAT患者左心室段性传导速度（CV）的影响。方法对179例患者进行PVI后，通过不同部位的起搏建立LA顺、逆行传播图。在两幅地图中测量了7个不同的LA段的节段cv。采用爆发性起搏诱导心房速性心律失常。结果11例患者（PMAT组）共诱发12个PMAT（顺时针旋转7个，逆时针旋转5个），56例患者（无诱导组）未诱发房性心动过速。比较PMAT组和无诱导组的节段性CVs，我们观察到PMAT组的CVs不仅在前房和间隔区，而且在顶房和底房区都有显著的降低。在没有或有小低压区的区域也观察到方向依赖的传导延迟，特别是在LA隔、外侧和底部。在PMAT组中，PMAT期间非常慢的传导区域始终与逆行或逆行传播期间CV减少最多的区域一致。此外，在起搏研究中发现的前LA传导延迟较大的方向与11例患者中9例的PMAT旋转方向相匹配。结论PMAT患者左心室有明显的节段性CVs，这可能影响心动过速回路的形成和旋转方向。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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