Three-dimensional electroanatomic mapping characteristics of superior vena cava myocardial sleeve and sinoatrial node in patients with atrial fibrillation

FIGURE 1. An example of mapping catheter-guided SVC activation mapping. Manipulating the mapping catheter along with the RA from the caudal to the cranial direction to reconstruct the 3D activation map of RA and SVC. At the junction of RA-SVC, both the proximal 1–2 electrode and the distal 3–4 electrode could record the SVC potential. Then, the catheter was slowly moved toward the cranial direction with 3–5 g pressure. When the SVC potential of the proximal electrode of the catheter just disappeared, and at the same time, the SVC potential of the distal electrode still existed (red arrow on the left plan), the plane of the proximal electrode of the catheter was indicated the end of SVC musculature sleeve. The myocardial sleeve length of SVC was defined as the vertical distance from the junction of RA-SVC to the distal end of the myocardial sleeve. The RA was divided into three equal parts in the right anterior oblique position, namely, high, middle, and low RA. Note that the red region indicates the location of the SAN. RA, right atrium; SVC, superior vena cava.

FIGURE 2. Subgroup analysis of LSVC in patients with atrial fibrillation (AF). (A) There was no difference between PAF and PsAF. (B) The length of the myocardial sleeve in men was longer than in women. (C) When the location of SAN was above the RA-SVC junction, the length of the SVC myocardial sleeve was longer than that below the junction. PAF, paroxysmal atrial fibrillation; PsAF, persistent atrial fibrillation; M, male; F, female; RA, right atrium; SAN, sinus node; SVC, superior vena cava, #p > 0.05; **p < 0.01.

FIGURE 3. Scatter plot of height and LSVC. A significant linear relationship between myocardial sleeve length and height (R = 0.43, p < 0.001). LSVC: SVC myocardial sleeve length.

FIGURE 4. A schematic illustration demonstrating the SAN location. (A) This case demonstrates the SAN located above the RA-SVC junction. (B) The SAN was below the RA-SVC junction. The yellow arrow indicates the location of the SAN. The white dotted line indicates the RA-SVC junction. RA, right atrium; SAN, sinus node; SVC, superior vena cava.