Published Online
on March 10, 2003

A more recent version of this article appeared on March 25, 2003

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Submitted on September 30, 2002
Revised on December 10, 2002
Accepted on December 10, 2002

Correlation Between Anatomy and Electrical Activation in Canine Pulmonary Veins

Akira Hamabe MD, Yuji Okuyama MD, PhD, Yasushi Miyauchi MD, Shengmei Zhou MD, Hui-Nam Pak MD, Hrayr S. Karagueuzian PhD, Michael C. Fishbein MD, and Peng-Sheng Chen MD^*

From the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and the Department of Pathology and Laboratory Medicine at the David Geffen School of Medicine, UCLA (M.C.F), Los Angeles, Calif.

^* To whom correspondence should be addressed. E-mail: chenp{at}cshs.org.

Background--The roles of complex muscle sleeve geometry and fiber orientation in the pulmonary veins (PVs) in wave-front propagation are poorly understood.

Methods and Results--We mapped the left superior PV (LSPV, n=7) and left inferior PV (LIPV, n=4) of dogs with 420 bipolar electrodes (1-mm resolution) and performed detailed histological examination. In the anterior LSPV-left atrial (LA) junction, myocardial muscle fibers were oriented perpendicular to PV blood flow. A wedge filled with connective tissues led to a complete muscle separation or an abrupt increase in muscle thickness between the PV and LA (0.42±0.12 versus 2.0±0.31 mm, P<0.01). Distal LSPV pacing resulted in conduction block at the anterior PV-LA junction, with double potentials. In contrast, the posterior LSPV-LA junction showed gradual muscle thickening and a fiber orientation parallel to the blood flow. The maximum PV muscle thickness in the anterior PV-LA junction is thinner than that in the posterior junction (0.83±0.15 versus 1.3±0.38 mm, P<0.01). Distal LIPV pacing showed multiple PV-LA breakthroughs, with segmental conduction block in the anterior PV-LA junction. The conduction block corresponded to segmental PV-LA muscle disconnection. Complex fiber orientations in the PV muscle sleeves away from the PV-LA junction were responsible for intra-PV conduction delay or block during rapid PV pacing.

Conclusions--We conclude that segmental muscle disconnection and differential muscle narrowing at PV-LA junctions and complex fiber orientations within the PV provide robust anatomical bases for conduction disturbance at the PV-LA junction and complex intra-PV conduction patterns.

Key words: fibrillation • mapping • electrophysiology • immunohistochemistry • pacing

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