Intra-Atrial Conduction Delay Revealed by Multisite Incremental Atrial Pacing is an Independent Marker of Remodeling in Human Atrial Fibrillation

Autor: Steven E, Williams, Nick W F, Linton, James, Harrison, Henry, Chubb, John, Whitaker, Jaswinder, Gill, Christopher A, Rinaldi, Reza, Razavi, Steven, Niederer, Matthew, Wright, Mark, O'Neill
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
atrial remodeling
AF
atrial fibrillation
S1S2block
the shortest S1S2 coupling interval that conducts from pacing site to left atrium
ΔEV
rate dependence of electrogram voltage
AF substrate
Electrocardiography
Heart Conduction System
HRA
high right atrium
Atrial Fibrillation
LA
left atrial
Humans
atrial fibrillation
cardiovascular diseases
Heart Atria
Aged
PAF
paroxysmal AF
ADT
activation dispersion time
ΔED
rate dependence of electrogram duration
Cardiac Pacing
Artificial
Middle Aged
CS
coronary sinus
ERP
effective refractory period
Pulmonary Veins
S1S2delay
the shortest S1S2 coupling interval conducting without decrement to the left atrium
ED
electrogram duration
EV
electrogram voltage
cardiovascular system
Female
New Research Paper
Electrophysiologic Techniques
Cardiac
electrophysiology testing
Zdroj: Jacc. Clinical Electrophysiology
Williams, S E, Linton, N W F, Harrison, J, Chubb, H, Whitaker, J, Gill, J, Rinaldi, C A, Razavi, R, Niederer, S, Wright, M & O'Neill, M 2017, ' Intra-Atrial Conduction Delay Revealed by Multisite Incremental Atrial Pacing is an Independent Marker of Remodeling in Human Atrial Fibrillation ', JACC: Clinical Electrophysiology, vol. 3, no. 9, pp. 1006-1017 . https://doi.org/10.1016/j.jacep.2017.02.012
ISSN: 2405-5018
2405-500X
DOI: 10.1016/j.jacep.2017.02.012
Popis: Objectives This study sought to characterize direction-dependent and coupling interval–dependent changes in left atrial conduction and electrogram morphology in uniformly classified patients with paroxysmal atrial fibrillation (AF) and normal bipolar voltage mapping. Background Although AF classifications are based on arrhythmia duration, the clinical course, and treatment response vary between patients within these groups. Electrophysiological mechanisms responsible for this variability are incompletely described. Methods Intracardiac contact mapping during incremental atrial pacing was used to characterize atrial conduction, activation dispersion, and electrogram morphology in 15 consecutive paroxysmal AF patients undergoing first-time pulmonary vein isolation. Outcome measures were vulnerability to AF induction at electrophysiology study and 2-year follow-up for arrhythmia recurrence. Results Conduction delay showed a bimodal distribution, occurring at either long (high right atrium pacing: 326 ± 13 ms; coronary sinus pacing: 319 ± 16 ms) or short (high right atrium pacing: 275 ± 11 ms; coronary sinus pacing: 271 ± 11 ms) extrastimulus coupling intervals. Arrhythmia recurrence was found only in patients with conduction delay at long extrastimulus coupling intervals, and patients with inducible AF were characterized by increased activation dispersion (activation dispersion time: 168 ± 29 ms vs. 136 ± 11 ms). Electrogram voltage and duration varied throughout the left atrium, between patients, and with pacing site but were not correlated with AF vulnerability or arrhythmia recurrence. Conclusions Within the single clinical entity of paroxysmal AF, incremental atrial pacing identified a spectrum of activation patterns correlating with AF vulnerability and arrhythmia recurrence. In contrast, electrogram morphology (characterized by electrogram voltage and duration) was highly variable and not associated with AF vulnerability or recurrence. An improved understanding of the electrical phenotype in AF could lead to improved mechanistic classifications.
Graphical abstract
Databáze: OpenAIRE
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