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Europace Advance Access originally published online on December 13, 2008
Europace 2009 11(2):169-177; doi:10.1093/europace/eun335
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Electrophysiology and Ablation

Non-invasive detection of conduction pathways to left atrium using magnetocardiography: validation by intra-cardiac electroanatomic mapping

Raija Jurkko1,2,*, Ville Mäntynen2,3, Jari M. Tapanainen1,2, Juha Montonen2, Heikki Väänänen3, Hannu Parikka1,2 and Lauri Toivonen1,2

1 Department of Cardiology Helsinki University Central Hospital, FI-00290 Helsinki, Finland; 2 BioMag Laboratory HUSLAB, Helsinki University Central Hospital, Helsinki, Finland; 3 Laboratory of Biomedical Engineering, Helsinki University of Technology, Espoo, Finland

Aims: Alteration in conduction from right to left atrium (LA) is linked to susceptibility to atrial fibrillation (AF). We examined whether different inter-atrial conduction pathways can be identified non-invasively by magnetocardiographic mapping (MCG).

Methods and results: In 27 patients undergoing catheter ablation of paroxysmal AF, LA activation sequence was determined during sinus rhythm using invasive electroanatomic mapping. Before this, 99-channel magnetocardiography was recorded over anterior chest. The orientation of the magnetic fields during the early (40–70 ms from P onset) and later part (last 50%) of LA depolarization was determined using pseudocurrent conversion. Breakthrough of electrical activation to LA occurred through Bachmann bundle (BB) in 14, margin of fossa ovalis (FO) in 3, coronary sinus ostial region (CS) in 2, and their combinations in 10 cases by invasive reference in total of 29 different P-waves. Based on the combination of pseudocurrent angles over early and late parts of LA activation, the MCG maps were divided to three types. These types correctly identified the LA breakthrough sites to BB, CS, FO, or their combinations in 27 of 29 (93%) cases.

Conclusion: Magnetocardiographic mapping seems capable of distinguishing inter-atrial conduction pathways. Recognizing the inter-atrial conduction pattern may assist in understanding the pathogenesis of AF and identifying the subgroups for patient-tailored therapy.

Key Words: Atrial fibrillation, Inter-atrial conduction, Electroanatomic mapping, Magnetocardiography

* Corresponding author. Tel: +358 9 4717 2442, Fax: +358 9 4717 4574, Email: raija.jurkko{at}2me.fi

Manuscript submitted 13 September 2008. Accepted after revision 11 November 2008.


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