Left Atrial Conduction Along the Coronary Sinus During Ectopic Atrial Tachycardia and Atrial Fibrillation:

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Abstract
Ntroduction: Correlation function analysis was applied to endocardial electrograms to investigate conduction patterns along the coronary sinus (CS) during sinus rhythm (SR) and atrial tachycardias. Methods and Results: Eighteen recordings were obtained from 14 patients suffering from supraventricular tachycardias. Five atrial fibrillation(AF) recordings were compared to 10 SR recordings and 3 ectopic atrial tachycardia (EAT) recordings. The maximum correlation coefficient was used to assess similarity between signals, i.e., if they originate from the samewavefront. The cumulative time delay, calculated as pairwise summation of interelectrode time delays was used as an indicator of activation sequence along CS. Method validation using SR showed right to left conduction with high correlations in 8 of 10 recordings indicating one single wavefront. EAT recordings showed consistent left to right conduction with left atrial foci and right to left with right atrial focus and lower correlations than SR. All 5 AFrecordings showed predominantly left to right conduction direction, also with correlations lower than SR.Conclusion: 1) Correlation function analysis can be used to assess agreement between signals and direction of activation spread. 2) Due to the position of CS, the results can be used to derive mechanisms of interatrial conduction. 3) Consistency in electrical activity propagation along CS iscommon in AF