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Type: Journal article
Title: High-density mapping of the sinus node in humans: Role of preferential pathways and the effect of remodeling
Author: Stiles, M.
Brooks, A.
Roberts-Thomson, K.
Kuklik, P.
John, B.
Young, G.
Kalman, J.
Sanders, P.
Citation: Journal of Cardiovascular Electrophysiology, 2010; 21(5):532-539
Publisher: Futura Publ Co
Issue Date: 2010
ISSN: 1045-3873
Statement of
Martin K. Stiles, Anthony G. Brooks, Kurt C. Roberts-Thomson, Pawel Kuklik, Bobby John, Glenn D. Young, Jonathan M. Kalman and Prashanthan Sanders
Abstract: <h4>Introduction</h4>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.<h4>Methods and results</h4>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 reference patients, and 19 +/- 12 mm (P = 0.045), 28 +/- 9 mm (P = 0.02) in patients with flutter. This resulted in caudal shifts in EA and SBO of 10 +/- 9 mm and 7 +/- 8 mm in reference patients but diminished shifts in patients with flutter; 4 +/- 7 mm and 4 +/- 6 mm.<h4>Conclusion</h4>The functional sinus node complex demonstrates dynamic changes in activation. There are preferential pathways of conduction from sinus node to atrial myocardium. The remodeled atria demonstrate longer conduction times along preferential pathways and a restricted functional sinus node complex.
Keywords: Vena Cava, Superior
Heart Conduction System
Sinoatrial Node
Atrial Flutter
Tachycardia, Supraventricular
Catheter Ablation
Middle Aged
Rights: © 2009 Wiley Periodicals, Inc.
DOI: 10.1111/j.1540-8167.2009.01644.x
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