Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Experimental methods D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-150 - Validity Of An Anatomical Approach To Determine The Sinoatrial Node Location During Ablation: Comparison With Electrophysiological Evaluation (ID 468)


Background: Superior vena cava (SVC) isolation must be performed at a certain distance above the sinoatrial node (SN) to avoid SN injury. However, the electrical location of the SN cannot always be obtained without restoring sinus rhythm.
Objective: To evaluate the usefulness of anatomically predicted SN (Anatomical SN: a
-SN) with intracardiac echocardiography (ICE) for predicting electrically confirmed atrial earliest activation site (electrical SN: e-SN).
Methods: The e-SN of the right atrium during sinus rhythm was obtained with a multipolar mapping catheter using a 3-dimensional anatomical mapping system (CARTO®3, EnSite Precision™). The geometrical point of the a-SN was depicted in the same map by placing an ablation catheter on the cranial edge of the crista terminalis, adjacent to the right atrial appendage on ICE, and set as the reference point. The relative height on the craniocaudal axis of the e-SN was measured.
Results: Of the 48 patients who underwent catheter ablation (male=36 [75%]; mean±SD: age, 63±13 years; heart rate [HR], 69±18 bpm), 46 (96%) who had AF ablation and 3 (6%) who had a prior right-side Maze procedure were included. The height of the e-SN was 0.6±9.6 (range: −20.8 to 16.0) mm and 90% were 10 mm or under from the anatomical SN. Although HR showed a weak positive correlation with the height of the e-SN (Pearson coefficient r=0.4, p<0.01), the highest point was similar regardless of the HR. Age, sex, and prior Maze procedure were not correlated.
Conclusion: Detecting the a-SN was useful for predicting the upper limit of the e-SN in majority of the patients. Meanwhile, there were some patients who had very high e-SN, acquiring the electrical map of the SN is important.