Document Detail

Characterization of atrial remodeling studied remote from episodes of typical atrial flutter.
MedLine Citation:
PMID:  20691311     Owner:  NLM     Status:  MEDLINE    
Atrial electrical remodeling has been shown after termination of atrial flutter (AFL); however, whether abnormalities persist beyond an arrhythmic episode is not known. We aimed to characterize the atrial substrate, remote from arrhythmia, in patients with typical AFL. We compared 20 patients, studied remote from episodes of typical AFL and without a history of atrial fibrillation, to 20 reference patients. Multipolar catheters placed at the lateral right atrium (RA), coronary sinus, crista terminalis, and septal RA measured the effective refractory period at 5 sites; conduction characteristics at the crista terminalis; and the conduction time along the lateral RA and coronary sinus. Electroanatomic right atrial maps were created to determine regional differences in voltage and conduction. Patients with AFL demonstrated the following compared to the reference patients: a larger right atrial volume (121 +/- 30 vs 83 +/- 24 ml, p = 0.005); a prolonged P-wave duration (122 +/- 18 vs 102 +/- 11 ms, p = 0.007); a longer right atrial activation time (107 +/- 23 vs 85 +/- 14 ms, p = 0.02); a prolonged conduction time along the lateral RA (67 +/- 4 vs 47 +/- 3 ms, p <0.001); a slower mean conduction velocity (1.2 +/- 0.2 vs 2.1 +/- 0.6 mm/ms, p <0.001); a greater proportion of fractionated electrographic findings (16 +/- 4% vs 10 +/- 6%, p = 0.006); more frequent abnormal electrographic findings at the crista terminalis (4.1 +/- 2.6 vs 1.0 +/- 1.1, p = 0.001); a prolonged corrected sinus node recovery time (318 +/- 71 vs 203 +/- 94 ms, p = 0.02); a trend toward greater effective refractory period (232 +/- 29 vs 213 +/- 12 ms, p = 0.06); and a lower voltage (2.1 +/- 0.5 vs 3.0 +/- 0.5 mV, p <0.001). In conclusion, studied remote from arrhythmia, patients with AFL demonstrated significant and diffuse atrial abnormalities characterized by structural changes, conduction abnormalities, and sinus node dysfunction. These persisting abnormalities characterize the substrate underlying typical AFL and may account for the subsequent development of atrial fibrillation.
Martin K Stiles; Christopher X Wong; Bobby John; Pawel Kuklik; Anthony G Brooks; Dennis H Lau; Hany Dimitri; Lauren Wilson; Glenn D Young; Prashanthan Sanders
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-09     Completed Date:  2010-09-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  528-34     Citation Subset:  AIM; IM    
Department of Cardiology, University of Adelaide, Adelaide, South Australia, Australia.
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MeSH Terms
Atrial Flutter / physiopathology*
Atrial Function, Left / physiology*
Electrophysiologic Techniques, Cardiac
Heart Atria / physiopathology*
Middle Aged
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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