ArticleHeart rhythm O22021
Feasibility of "natural surface" epicardial mapping from the pulmonary artery for management of atrial arrhythmias.
Article in Heart rhythm O2, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 5 citations in OpenAlex.
- Electric field effects of pulsed field ablation through adjacent non-cardiac tissues in anFrontiers in cardiovascular medicine · 2026Article
- Direct Epicardial Mapping and Ablation Revealing Three-Dimensional Roof-Dependent Macroreentrant Atrial Tachycardia Breaking Into Bachmann's Bundle.Clinical case reports · 2025Article
- Indirect epicardial targeting of left atrial tachycardia using Bachmann's bundle: A case report of successful ablation from pulmonary artery.Journal of arrhythmia · 2025Article
- Electrophysiological characteristics of epicardial atrial tachycardias and endocardial breakthrough site targeting for ablation: a single center experience.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe right and left pulmonary artery branches (RPA, LPA) overlie inaccessible left atrial (LA) epicardium, containing the Bachmann bundle (BB), that participate in arrhythmia pathogenesis and offer an opportunity for natural surface epicardial mapping (NSEM).
objectiveWe sought to assess the feasibility of NSEM of BB and LA roof arrhythmias.
methodsElectrogram recording, pacing, and ablation was performed in 2 swine. Subsequently, NSEM and pacing from the RPA and LPA was performed in 11 consecutive patients undergoing ablation of atrial fibrillation or flutter. Pacing entrainment and ablation of LA epicardium, from the pulmonary artery (PA), was performed in cases of atypical flutter.
resultsSwine specimens revealed no vascular disruption and LA epicardial lesions up to 7 mm in diameter and 3 mm in depth. In clinical cases, RPA mapping was performed in 11 (100%) and LPA mapping in 6 (55%) patients. Simultaneous leftward activation of the BB followed by rightward activation of the opposing LA endocardium was recorded during crista pacing. Right and left PA median signal amplitudes were 0.71 mV and 0.30 mV, respectively. Endocardial LA median distance was 9 mm to the RPA and 15.6 mm to the LPA and LA capture was successful in 7 of 8 (88%). In cases of atypical flutter, entrainment was successful in 3 of 3 (100%) and ablation was performed.
conclusionPA NSEM can enable safe recording and entrainment of the BB, providing otherwise inaccessible epicaridal arrhythmia measurements. The safety and efficacy of ablation from the PA requires further study.
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