Document Detail


Paroxysmal atrial fibrillation is associated with increased intra-atrial conduction delay.
MedLine Citation:
PMID:  18936043     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: A novel electrophysiological technique, paced electrogram fractionation analysis (PEFA), which measures activation delay of stimulated beats through the myocardium, has shown that long delays in activation are strongly associated with sudden cardiac death due to ventricular fibrillation. The aim of our study was to determine whether there are differences in intra-atrial conduction in patients with and without paroxysmal atrial fibrillation (PAF) using PEFA. Twenty patients (15 women) in the mean age 54.7 +/- 16.6 years, scheduled for transcatheter ablation of their arrhythmias, were divided into two groups: 10 controls without PAF and 10 patients with PAF. METHODS AND RESULTS: During PEFA, pacing and recording catheters were placed in the coronary sinus (three sites: distal, mid, and proximal) and at four right atrium sites: crista terminalis (one site), RA isthmus (one site), and interatrial septum (two sites). The PEFA protocol involves pacing from one site and recording electrograms from other six sites. A decremental sequence, delivered at one site, had a cycle length of 490 ms (S1S1) with an extrastimulus inserted every third beat whose coupling interval (S1S2) is reduced by 1 ms on each occasion. This process is repeated from each atrial site. The S1S2 at which electrogram duration starts to prolong, and the increase in electrogram duration is determined at all sites. In three patients from the PAF group, atrial fibrillation was induced during PEFA and it was terminated by electrical cardioversion. No other complications were noted. The patients with PAF, compared with the control group, have abrupt increases in the electrogram duration, which occur, at significantly longer S1S2 (P < 0.0001). There were also significantly longer intra-atrial delays in the intrinsic deflection of the electrogram in PAF patient vs. control group (P < 0.0001). CONCLUSIONS: Comparison of PAF and non-AF patient groups showed that intra-atrial conduction delay start in the PAF group earlier (with longer S1S2 intervals) and they are significantly longer in the PAF group. This suggests that atria in patients with PAF are diffusely diseased and that the measured activation delays form one component of an arrhythmogenic substrate.
Authors:
Mariusz Pytkowski; Agnieszka Jankowska; Aleksander Maciag; Ilona Kowalik; Maciej Sterlinski; Hanna Szwed; Richard C Saumarez
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-19
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  10     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2009-02-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  1415-20     Citation Subset:  IM    
Affiliation:
Coronary Artery Disease Department, Institute of Cardiology, Warsaw, Poland. address: mpytkowski@ikard.pl
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / diagnosis*,  physiopathology*
Body Surface Potential Mapping / methods*
Female
Heart Conduction System / physiopathology*
Humans
Male
Middle Aged

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


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