loading page

Unusual response to atrial entrainment pacing dependent on pacing current strength: What is the mechanism?
  • Atsushi Doi,
  • Naoko Miyazaki,
  • Takayuki Yamada
Atsushi Doi
Otemae Byoin

Corresponding Author:[email protected]

Author Profile
Naoko Miyazaki
Otemae Byoin
Author Profile
Takayuki Yamada
Otemae Byoin
Author Profile


A 77-year-old woman with palpitations was referred for a second radiofrequency ablation for persistent atrial tachycardia (AT). She previously underwent pulmonary vein (PV) isolation for paroxysmal atrial fibrillation, linear ablation between the 3’o clock position of the mitral annulus (MA) and left PV from the endocardium, and ablation inside the coronary sinus (CS) for perimitral atrial tachycardia (PMAT) in the first procedure. A baseline 12-lead electrocardiogram in the second procedure showed stable AT with a cycle length (CL) of 250 ms. No PV reconnection was observed. The CS catheter was placed from 3:30 to 5:00 on the MA, and a proximal-to-distal pattern of CS activation during AT was observed. Activation mapping in the left atrial (LA) endocardium using a three-dimensional mapping system (CARTO3, Biosense Webster, Diamond Bar, CA, USA) revealed a sequence of counterclockwise rotations of the MA. Figures 1A and 1B show the intracardiac electrograms during high-output (20 V) and low-output (5 V) atrial entrainment pacing at a pacing CL of 240ms from CS 3,4, which corresponds to the 4’o clock position of the MA. Dose residual conduction occur across the mitral isthmus (MI) endocardium, epicardium, or both? What is the electrophysiological mechanism during high- and low-output entrainment pacing?
16 Mar 2022Submitted to Journal of Cardiovascular Electrophysiology
17 Mar 2022Submission Checks Completed
17 Mar 2022Assigned to Editor
19 Mar 2022Review(s) Completed, Editorial Evaluation Pending
19 Mar 2022Editorial Decision: Revise Minor
28 Mar 20221st Revision Received
30 Mar 2022Submission Checks Completed
30 Mar 2022Assigned to Editor
30 Mar 2022Review(s) Completed, Editorial Evaluation Pending
04 Apr 2022Editorial Decision: Accept
13 Apr 2022Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15488