In vivo peak frequency mapping reliably identified the sinoatrial node exit zones and preferential conduction pathways using a 350-450 Hz frequency band, supported by preclinical anatomic validation.
Observational
Does high-density endocardial electroanatomic mapping with peak frequency analysis accurately identify sinoatrial node exit zones and Bachmann bundle conduction pathways?
Integrating human in vivo peak frequency mapping with preclinical anatomic validation provides a reliable framework for identifying sinoatrial node exit zones and Bachmann bundle-mediated conduction.
BACKGROUND: In vivo electroanatomic mapping has enabled functional characterization of the human sinoatrial node (SAN), yet precise localization of SAN exit zones (SAN-EZs) and preferential conduction pathways-particularly along the Bachmann bundle (BB)-remains challenging without direct anatomic validation. OBJECTIVE: This study aimed to establish a translational framework integrating human in vivo peak frequency (PF) mapping with preclinical anatomic and histologic validation of the SAN-BB conduction axis. METHODS: High-density endocardial electroanatomic mapping with PF analysis was performed in patients with inappropriate sinus tachycardia, sick sinus syndrome, and normal SAN function. Emphasis maps combining local activation time and PF were used to identify the SAN-EZ and preferential conduction pathways. To address anatomy, complementary preclinical studies were performed using contrast-enhanced micro-computed tomography, 3-dimensional reconstruction, and histology of donor human hearts, focusing on BB microstructure, insertion sites, and myocyte orientation. Frequency analysis was additionally applied to preclinical hearts to compare the BB with the surrounding right atrial myocardium. RESULTS: In vivo PF mapping reliably identified the SAN-EZ and preferential conduction pathways using a 350-450 Hz frequency band. Patients with sick sinus syndrome exhibited reduced SAN-EZ overlap and fewer superior and septal pathways. Preclinical micro-computed tomography and histology in cadaveric human hearts confirmed the anatomic substrate underlying septal conduction. Frequency analysis of swine hearts revealed higher dominant frequencies within the BB than adjacent right atrial myocardium, supporting in vivo findings. CONCLUSION: By integrating human functional mapping with preclinical anatomic and histologic validation, this study provides a translational framework for PF-based identification of the SAN-EZ and BB-mediated conduction.
Pannone et al. (Wed,) conducted a observational in Inappropriate sinus tachycardia, sick sinus syndrome, and normal SAN function. High-density endocardial electroanatomic mapping with peak frequency analysis was evaluated on Identification of the SAN-EZ and preferential conduction pathways. In vivo peak frequency mapping reliably identified the sinoatrial node exit zones and preferential conduction pathways using a 350-450 Hz frequency band, supported by preclinical anatomic validation.