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(Circulation. 2004;110:2083-2089.)
© 2004 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Human Study of Biatrial Electrical Coupling

Determinants of Endocardial Septal Activation and Conduction Over Interatrial Connections

Robert Lemery, MD; Luc Soucie, MSc; Bruno Martin, MBBS; Anthony S.L. Tang, MD; Martin Green, MD; Jeff Healey, MD

From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Reprint requests to Robert Lemery, MD, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7. E-mail rlemery{at}ottawaheart.ca

Received January 21, 2004; revision received March 16, 2004; accepted March 19, 2004.

Background— The relative contribution of the atrial septum and interatrial connections to biatrial activation is a fundamental concept of human cardiac electrophysiology that has yet to be fully characterized. The purpose of the present study was to determine how both atria are coupled electrically.

Methods and Results— Twenty patients (16 men; mean age 54±11years) with a history of symptomatic atrial fibrillation (AF) underwent simultaneous biatrial noncontact mapping before catheter ablation of AF. The multiple electrode array catheters were positioned, respectively, in the left atrium (LA; transseptally) and the right atrium (RA). In all but 2 patients, isopotential maps revealed that endocardial septal activations of the RA and LA were separate, independent, and asynchronous of each other. Interatrial conduction was related to the site of initial atrial depolarization, revealing conduction over Bachmann’s bundle in all patients during sinus rhythm, high RA pacing, and pacing from the LA appendage. Pacing from the coronary sinus was associated with conduction over the interatrial connection at the level of the coronary sinus in all patients, and conduction over Bachmann’s bundle also occurred in 5 (26%) of 19 patients. Interatrial conduction over the fossa ovalis occurred in only 2 (2%) of the 116 segments analyzed.

Conclusions— Electrical coupling of the RA and LA in humans is predominantly provided by muscular connections at the level of Bachmann’s bundle and the coronary sinus. The true septum (the fossa ovalis and its limbus) of the RA and LA is asynchronous and discordant, usually without contralateral conduction during sinus rhythm or atrial pacing.

Key Words: atrium • fibrillation • electrophysiology

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