Endo-epicardial mapping of human sinus node in vivo: Novel electrophysiologic findings and anatomic correlations

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2026-02-01 Epub Date: 2025-03-20 DOI:10.1016/j.hrthm.2025.03.1966

Ivan Eltsov MD , Luigi Pannone MD, PhD , Domenico Giovanni Della Rocca MD, PhD , Dhanunjaya Lakkireddy MD , Thomas M. Beaver MD , Chad R. Brodt MD , Giacomo Talevi MSc , Antonio Sorgente MD, PhD , Ingrid Overeinder MD , Rani Kronenberger MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Andrea Sarkozy MD, PhD , Pedro Brugada MD, PhD, FHRS , Ali Gharaviri PhD , Gian Battista Chierchia MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD, FHRS

{"title":"Endo-epicardial mapping of human sinus node in vivo: Novel electrophysiologic findings and anatomic correlations","authors":"Ivan Eltsov MD , Luigi Pannone MD, PhD , Domenico Giovanni Della Rocca MD, PhD , Dhanunjaya Lakkireddy MD , Thomas M. Beaver MD , Chad R. Brodt MD , Giacomo Talevi MSc , Antonio Sorgente MD, PhD , Ingrid Overeinder MD , Rani Kronenberger MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Andrea Sarkozy MD, PhD , Pedro Brugada MD, PhD, FHRS , Ali Gharaviri PhD , Gian Battista Chierchia MD, PhD , Mark La Meir MD, PhD , Carlo de Asmundis MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.03.1966","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The human sinoatrial node<span> (SAN) pacemaker is a complex structure located at the right atrium (RA)–superior vena cava (SVC) junction.</span></div></div><div><h3>Objective</h3><div><span>This study aimed to perform in vivo endocardial and epicardial electroanatomic mapping of human SAN in inappropriate </span>sinus node tachycardia<span> (IST) and to correlate electrical findings with anatomic observations from thoracoscopy during hybrid SAN-sparing IST ablation.</span></div></div><div><h3>Methods</h3><div><span>All consecutive patients with diagnosis of symptomatic IST, refractory to or intolerant of drugs, and endocardial and epicardial mapping of SAN during hybrid ablation were included. Local activation time was defined by steepest −dV/dT on unipolar </span>electrogram (EGM). Exit zone (EZ) was defined as the earliest activation site on endocardial and epicardial maps. Endo-epicardial delay was the time difference between the first endo-epicardial activations. Bipolar EGM morphology and SVC sleeve extension were analyzed.</div></div><div><h3>Results</h3><div>A total of 61 patients were included. The SAN-EZ area was 1.4 ± 0.6 cm<sup>2</sup>; it was located in the superior anterior region of the RA in 46 (75.4%) patients and in the mid RA in 15 (24.6%) patients. The earliest activation occurred on epicardial SAN-EZ in all patients. The local activation time of the epicardial vs endocardial SAN-EZ was −30.8 ms vs −12.4 ms (<em>P</em> < .001). Endo-epicardial delay was 19.7 ms. Bipolar EGM reversed polarity at SAN-EZs was observed in 43 (70.5%) patients. SVC sleeve extension was 31.2 mm and inversely correlated with age.</div></div><div><h3>Conclusion</h3><div>The earliest SAN-EZ was found in the epicardium. Bipolar EGM reversed polarity is a novel electrophysiologic marker for SAN-EZs.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 2","pages":"Pages 234-242"},"PeriodicalIF":5.7000,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527125022283","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/20 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The human sinoatrial node (SAN) pacemaker is a complex structure located at the right atrium (RA)–superior vena cava (SVC) junction.

Objective

This study aimed to perform in vivo endocardial and epicardial electroanatomic mapping of human SAN in inappropriate sinus node tachycardia (IST) and to correlate electrical findings with anatomic observations from thoracoscopy during hybrid SAN-sparing IST ablation.

Methods

All consecutive patients with diagnosis of symptomatic IST, refractory to or intolerant of drugs, and endocardial and epicardial mapping of SAN during hybrid ablation were included. Local activation time was defined by steepest −dV/dT on unipolar electrogram (EGM). Exit zone (EZ) was defined as the earliest activation site on endocardial and epicardial maps. Endo-epicardial delay was the time difference between the first endo-epicardial activations. Bipolar EGM morphology and SVC sleeve extension were analyzed.

Results

A total of 61 patients were included. The SAN-EZ area was 1.4 ± 0.6 cm²; it was located in the superior anterior region of the RA in 46 (75.4%) patients and in the mid RA in 15 (24.6%) patients. The earliest activation occurred on epicardial SAN-EZ in all patients. The local activation time of the epicardial vs endocardial SAN-EZ was −30.8 ms vs −12.4 ms (P < .001). Endo-epicardial delay was 19.7 ms. Bipolar EGM reversed polarity at SAN-EZs was observed in 43 (70.5%) patients. SVC sleeve extension was 31.2 mm and inversely correlated with age.

Conclusion

The earliest SAN-EZ was found in the epicardium. Bipolar EGM reversed polarity is a novel electrophysiologic marker for SAN-EZs.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

人体内窦房结心外膜内定位：新的电生理发现和解剖学相关性。

背景：人窦房结（SAN）起搏器是位于右心房-上腔静脉（SVC）交界处的复杂结构。目的：本研究旨在(1)对不适当窦房结心动过速（IST）患者进行体内心内膜和心外膜电解剖定位（EAM），(2)在混合SAN保留IST消融过程中，将电结果与胸腔镜解剖观察相关联。方法：所有连续的1)诊断为症状性IST，药物难治性或不耐受的患者，2)混合消融过程中心内膜和心外膜SAN定位。局部激活时间（LAT）用单极电图（EGM）上最陡的-dV/dT来定义。出口区（SAN-EZ）定义为心内膜图和心外膜图上最早的激活位点。心外膜内延迟（EED）是指首次心外膜内激活之间的时间差。分析了双极EGM形态和SVC套筒伸长情况。结果：共纳入61例患者。SAN-EZ面积为1.4 cm2±0.6,46例（75.4%）患者位于RA的上前区，15例（24.6%）患者位于RA的中部。在所有患者中，最早的激活发生在心外膜SAN-EZ。心外膜和心内膜SAN-EZ的LAT分别为-30.8 ms和-12.4 ms。结论：SAN-EZ最早出现在心外膜。双极EGM反极性是一种新的SAN-EZs电生理标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.