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Analysis of the Mechanisms Initiating Random Wave Propagation at the Onset of Atrial Fibrillation Using Non-Contact Mapping: Role of Complex Fractionated Electrogram Region.
MedLine Citation:
PMID:  21354334     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The complex fractionated atrial electrogram (CFAE) region has been suggested to contribute to the maintenance of atrial fibrillation (AF), but its role for the initiation of AF has not been clarified. OBJECTIVE: We analyzed the mechanisms of the initiation of random reentrant wave propagation at AF onset, especially in relation to CFAE region. METHODS: Endocardial mapping of the left atrium using a three-dimensional non-contact mapping system was performed in 19 patients. RESULTS: Thirty-two spontaneous AF onset episodes, which were initiated by the focal repetitive discharges (8.6±8.6 beats), deriving from the pulmonary veins (PV) (n=17) and from non-PV CFAE regions (n=15) were observed. The coupling intervals of the focal discharges that initiated AF (AF-D) were significantly shorter than those that did not initiate AF (non-AF-D) (179±33 vs. 217±45 msec, p=0.0005). Following the AF-D, localized conduction blocks occurred in the CFAE region. Subsequently, the waves propagated to the remainder of the atrium, accompanying the anchored activation around the localized conduction block lines in the CFAE regions. Left atrial activation times of AF-D were significantly longer than those of non-AF-D (151±35 vs. 83±17 msec, p<0.0001). These longer activation times following AF-D enabled the waves to reenter the previously blocked CFAE region from the opposite direction and thus the meandering reentrant wave propagation was initiated. CONCLUSION: Unidirectional conduction block in the CFAE region and subsequent prolonged left atrial activation time following short coupled premature discharge were the underlying mechanisms of AF initiation, suggesting the importance of CFAE region as the substrate for AF onset.
Authors:
Hiroshige Yamabe; Kenji Morihisa; Junjiroh Koyama; Koji Enomoto; Hisanori Kanazawa; Hisao Ogawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-23
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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