Document Detail

Electrophysiological and electroanatomic characterization of the atria in sinus node disease: evidence of diffuse atrial remodeling.
MedLine Citation:
PMID:  15007004     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The normal sinus pacemaker complex is an extensive structure within the right atrium. We hypothesized that patients with sinus node disease (SND) would have evidence of diffuse atrial abnormalities. METHODS AND RESULTS: Sixteen patients with symptomatic SND and 16 age-matched controls were studied. The following were evaluated: effective refractory periods (ERPs) from the high and low lateral right atrium (RA), high septal RA, and distal coronary sinus (CS); conduction time along the CS and lateral RA; P-wave duration; and conduction at the crista terminalis. Electroanatomic mapping was performed to define the sinus node complex and determine regional conduction velocity, double potentials, fractionated electrograms, regional voltage, and areas of electrical silence. Patients with SND demonstrated significant increase in atrial ERP at all right atrial sites, increased atrial conduction time along the lateral RA and CS, prolongation of the P-wave duration, and greater number and duration of double potentials along the crista terminalis. Electroanatomic mapping demonstrated the sinus node complex in SND to be more often unicentric, localized to the low crista terminalis at the site of the largest residual voltage amplitude. There was significant regional conduction slowing with double potentials and fractionation associated with areas of low voltage and electrical silence (or scar). CONCLUSIONS: SND is associated with diffuse atrial remodeling characterized by structural change, conduction abnormalities, and increased right atrial refractoriness. There was a change in the nature of sinus pacemaker activity with loss of the normal multicentric pattern of activation, caudal shift of the pacemaker complex, and abnormal and circuitous conduction around lines of conduction block.
Prashanthan Sanders; Joseph B Morton; Peter M Kistler; Steven J Spence; Neil C Davidson; Azlan Hussin; Jitendra K Vohra; Paul B Sparks; Jonathan M Kalman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2004-03-08
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-30     Completed Date:  2004-07-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1514-22     Citation Subset:  AIM; IM    
Department of Cardiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
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MeSH Terms
Action Potentials
Arrhythmias, Cardiac / pathology*,  physiopathology
Atrial Fibrillation / etiology,  pathology,  physiopathology
Atrial Function, Right*
Cardiac Pacing, Artificial
Heart Atria / pathology*,  physiopathology
Heart Conduction System / physiopathology
Middle Aged
Neural Conduction
Sinoatrial Node / physiopathology*

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

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