Mapping-guided atrial lead placement determines optimal conduction across Bachmann’s bundle: a rationale for patient-tailored pacing therapy

Figures

• 

  Figure 1. Example of the pacing protocol. (A) Schematic scheme of the electrode position at BB and three pacing locations (RAA, LRA, and LAA). (B) Example of colour-coded activation patterns during SR and RAA, LRA, and LAA pacing. The thick black lines represent CB; isochronal lines are drawn every 10 ms. (C) Representative EGMs recorded during the pacing protocol as in B. BB, Bachmann’s bundle; CB, conduction block; ICV, inferior caval vein; LAA, left atrial appendage; LRA, inferior right atrium; RAA, right atrial appendage; SCV, superior caval vein; SR, sinus rhythm.

• 

  Figure 2. Variation of activation patterns during LRA pacing. Examples of BB activation during LRA pacing. Thick black lines represent CB; isochronal lines are drawn every 10 ms. FD, fractionation duration; FP, fractionated potentials; LAA, left atrial appendage; LDP, long double potentials; LRA, lower right atrium; LVA, low-voltage areas; RAA, right atrial appendage; RSPV, right superior pulmonary vein; SDP, short double potentials; SCV, superior caval vein; SP, single potentials; SR, sinus rhythm.

• 

  Figure 3. Changes in conduction features during pacing. Inter-individual variation in effect of pacing from either RAA (left), LRA (middle) and LAA (right). The arrows indicate statistical significance. The numbers indicate the amount of patients with either an increase or decrease. cCDCB, continuous conduction delay/block; CV, conduction velocity; LAA, left atrial appendage; LRA, lower right atrium; RAA, right atrial appendage; SR, sinus rhythm; TAT, total activation time.

• 

  Figure 4. Effect of pacing on electrogram morphology. Inter-individual variation in effect of pacing from either RAA (left), LRA (middle), and LAA (right). The arrows indicate statistical significance. The numbers indicate the amount of patients with either an increase or decrease. FP, fractionated potentials; LAA, left atrial appendage; LDP, long double potentials; LRA, lower right atrium; LVA, low-voltage areas; RAA, right atrial appendage; SR, sinus rhythm.