Provocation and localization of atrial ectopy in patients with atrial septal defects

Figures

• 

  Fig. 1. Holter lead configuration and P wave angle calculation using a sinus rhythm example. A; Top panel shows Holter electrode placement with bottom panel depicting the three channels obtained, B; Example of Holter electrocardiograms obtained during sinus rhythm with P waves highlighted. C; Examples of how P wave amplitude was measured across all three P waves

• 

  Fig. 2. Right and left atrial voltage map highlighting the position of the ablation catheter (left, yellow star) on the lateral right atrial wall and the Pentaray catheter on the posterior left atrial wall (right, yellow star) during isoprenaline infusion. B; Corresponding recording made during sinus rhythm at the start of the infusion. Blue electrograms represent surface ECG leads, yellow electrograms are recorded from the ablation catheter, white electrograms are recorded from the multipolar Pentaray catheter and green electrograms from the 318 coronary sinus decapolar catheter

• 

  Fig. 3. A; Right and left atrial sites paced with the ablation catheter during the invasive validation protocol. B; Breakdown of right (top) and left (bottom) atrial sites paced in both study groups. C; Fluoroscopic image of ablation catheter at high lateral right atrial wall and corresponding Holter recording obtained during pacing at 600ms. >D; Fluoroscopic image of ablation catheter at ostium of left superior pulmonary vein and corresponding Holter recording obtained during pacing at 600ms

• 

  Fig. 4. A; Breakdown of angles falling between 90-300° vs <90/> 305° for each left and right atrial paced site in ASD patients. B; Graphical representation of angles described as either right or left atrial for the purpose of the retrospective study in ASD patients (based on analysis of atrial sites paced in the validation cohort).C;Breakdown of angles falling between 90-300° vs <90/> 300° for each left and right atrial paced site in control patients. D; Graphical representation of angles described as either right or left atrial for the purpose of the retrospective study in control patients

• 

  Fig. 5. A The percentage of patients with right vs left sided ectopy during 24-hour ambulatory Holter monitoring. B; The percentage of patients with provoked right vs left sided ectopy during isoprenaline infusion

• 

  Fig. 6. A; Initiation of AF with a left atrial ectopic beat in a control patient. Earliest activation is seen on the Pentaray catheter indicated by the white arrow. B; close up view of same. C; AF continuing in the same patient