Right atrial free wall conduction velocity and degree of anisotropy in patients with stable sinus rhythm studied during open heart surgery

Aims Although the perpetuation of several supraventricular arrhythmias is critically dependent upon intra-atrial conduction, the literature lacks detailed information on normal values of conduction velocity and degree of anisotropy. In order to explore these factors further, we have measured conduction velocities at the right atrial free wall during sinus rhythm and during atrial pacing in four directions parallel and perpendicular to the atrioventricular groove in patients with normal atria and stable sinus rhythm. Methods and Results Using a Bard Cardiac Mapping System, atrial ECGs were recorded using a 3×4cm electrode array with 56 equally spaced bipolar electrodes in 12 patients undergoing open heart surgery due to ischaemic heart disease or Wolff–Parkinson–White syndrome. A bipolar pen probe connected to a Medtronic 5328 stimulator was used for pacing at a 10% higher rate than sinus rhythm. The local activation times were manually set and isochronal activation maps were created for each recording. The conduction velocities were calculated from the activation maps over a distance ranging from 2·2 to 4·2cm. The majority of the activation maps showed no signs of anisotropy; the others had less than 15% spatial inhomo-geneity of conduction. Mean conduction velocity, calculated from five consecutive beats, was 88±9cm.s−1(mean±SD), ranging between 68±4 and 103±3cm.s−1during sinus rhythm. Mean conduction velocity during atrial pacing was 81±16cm.s−1at a propagation direction of 0°, 74±14cm.s−1at a 90° direction, 79±12cm.s−1at 180° and 78±20cm.s−1at 270°, where 0° was parallel to the atrioventricular groove in the cranial direction and the angle increased counter-clockwise. Mean conduction velocity during sinus rhythm was significantly higher (P<0·05) than during atrial pacing at the 90° and 180° directions but not compared to atrial pacing at 0° or 270°. There was no significant difference in mean conduction velocity in different directions during atrial pacing. Conclusion Although anisotropy was documented during conduction velocity in individual cases, conduction velocity was not dependent on propagation direction at the epi-cardial right atrial free wall in patients with stable sinus rhythm. These findings do not exclude the presence of internodal preferential pathways as these are located subepicardially and a marked transmural discordance in activation has previously been documented in the vicinity of such pathways.