Detection of changes in atrial endocardial activation with use of an orthogonal catheter

Edward P. Gerstenfeld, Alan V. Sahakian, Jeffrey M. Baerman, Kristina M. Ropella, Steven Swiryn*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


The ability of a catheter with an orthogonal electrode configuration to sense differences in the direction of local atrial endocardial activation was tested in 18 consecutive patients with intact retrograde conduction. In all 18, discrimination of anterograde from retrograde conduction at a single atrial site was examined; in 5 of the 18, multiple sites were examined to determine if the discriminatory ability of the catheter was site dependent. The catheter was specially designed with bipoles in the x, y and z directions. A vector was computed for each electrogram during anterograde and retrograde conduction. Electrogram amplitude along the standard bipole was also compared for anterograde and retrograde conduction. Mean electrogram amplitude for the standard bipole was significantly different for anterograde than for retrograde conduction in 17 of 18 patients (mean ± SD 4 ± 1.9 vs. 2.7 ± 1.3 mV; p < 0.005), with complete separation of amplitude distributions in 4 patients. The electrogram vector during anterograde conduction was significantly different from that during retrograde conduction in all 18 patients (p < 0.0001), with complete separation of vector distributions in 14. In some patients with multiple site recordings, the choice of site greatly affected separation based on electrogram amplitude or vector, or both. The orthogonal catheter can be used to sense directional differences in local endocardial activation. The catheter shows promise for discriminating anterograde from retrograde conduction and examining the direction of endocardial activation in the heart during an electrophysiologic examination.

Original languageEnglish (US)
Pages (from-to)1034-1042
Number of pages9
JournalJournal of the American College of Cardiology
Issue number4
StatePublished - Oct 1991

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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