Analysis of in-silico body surface P-wave integral maps show important differences depending on the connections between coronary sinus and left atrium

The electrical connections between the atrial coronary sinus (CS) and the left atrial (LA) myocardium have an effect on the overall atrial activation pattern and the P-wave morphology. In this study, we use our validated multi-scale 3D human atrial-torso model to elucidate which electro-anatomical configuration of connections between CS and LA more accurately reproduces a set of body surface P-wave integral maps (BSPiM) acquired in the clinic. We performed atrial biophysical simulations by pacing in distal and proximal LA sites. The corresponding in-silico BSPiM were then computed and compared with published clinical patterns obtained from patients. Important differences in BSPiM were observed depending on the presence or absence of CS-LA electrical connections. Furthermore, when these junctions exist, the patterns slightly differ among themselves depending on their distal or proximal location with respect to the ostium of the CS.