Novel atrial pace-mapping technique based on dual-chamber electrograms to detect non–pulmonary vein foci

Figures

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  Figure 1. A: Intracardiac recordings showing sinus rhythm (yellow arrow) and atrial fibrillation initiation from a non–pulmonary vein trigger (pink arrow). B: Reference signals of trigger premature atrial complex recorded from the coronary sinus (CS) and right atrium (RA). C: Representative examples of the iPASO (Intracardiac Pace Match Scoring) technique. The upper panels show the pace match score of the paced signals and reference electrograms of 0.39.

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  Figure 2. Representative example of an iPASO (Intracardiac Pace Match Scoring) map. The highest matching score is 0.90, calculated as -90 ms, and the scores at the surrounding area are 0.78 (-78 ms, orange), 0.45 (-45 ms, blue), and 0.39 (-39 ms, blue). In other words, the highest score was displayed at the earliest activation site (EAS), similar to a centrifugal pattern with an EAS in the left atrial anterior wall. In this manner, the high and low matching scores obtained from the pace map can be displayed in the mapping, which is useful for determining the origin of the trigger foci.

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  Figure 3. The iPASO (Intracardiac Pace Match Scoring) map of case 2. The earliest activation site of the trigger foci was the coronary sinus proximal region (pink). In this case, the highest score was 0.90 (-90 ms), and the surrounding scores were 0.77 (-77 ms), 0.45 (-45 ms), and 0.39 (-39 ms). A centrifugal pattern with the earliest activation site at the 12 o’clock position of the tricuspid annulus was observed (Figure 2).