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Simultaneous biatrial computerized mapping during permanent atrial fibrillation in patients with organic heart
Tsu-Juey Wu1, Rahul N Doshi, Hsun-Lun A Huang
1Department of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, CA 90048, USA.
Insights
In patients with permanent atrial fibrillation (AF) and heart disease, rapid electrical activities were found near the pulmonary veins in the left atrium. These findings clarify AF activation patterns in complex cardiac conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Activation patterns in permanent atrial fibrillation (AF) with organic heart disease remain poorly understood.
- Investigating the electrophysiological substrate of AF in patients with underlying cardiac pathology is crucial.
Purpose of the Study:
- To elucidate the epicardial activation patterns during permanent atrial fibrillation (AF) in patients with organic heart disease.
- To compare electrical activation characteristics between the right atrium (RA) and left atrium (LA) in this patient cohort.
Main Methods:
- Simultaneous epicardial mapping of the RA free wall and LA posterior wall using 224 bipolar electrodes.
- High-resolution (3-mm) mapping to identify wavefronts, conduction blocks, and sites of rapid repetitive activities.
- Analysis of activation cycle length and dominant frequencies in both atria.
Main Results:
- Frequent large wavefronts and conduction blocks were observed in the RA, often correlating with anatomical structures.
- Multiple sites of rapid repetitive activities were consistently identified in the LA, particularly near the pulmonary veins (PVs).
- The LA demonstrated a significantly shorter mean activation cycle length and higher dominant frequency compared to the RA.
Conclusions:
- Permanent AF in patients with organic heart disease is characterized by shorter activation cycle lengths in the LA posterior wall compared to the RA free wall.
- Rapid repetitive electrical activities, originating near the PVs, are a consistent finding in the LA posterior wall during AF in this population.
Introduction:
Activation patterns during permanent atrial fibrillation (AF) in patients with organic heart diseases are unclear.
Methods And Results:
We studied six patients with permanent AF and organic heart diseases undergoing surgery. The duration of AF averaged 4.9+/-7.6 years. Computerized epicardial mappings of the right atrial (RA) free wall and the left atrial (LA) posterior wall were simultaneously performed with 224 bipolar electrodes at 3-mm spatial resolution. In the RA, large wavefronts and conduction blocks were frequently observed. The lines of block correlated with the crista terminalis and large pectinate muscles. In contrast, the LA had rapid repetitive activities originated from corners of the electrode plaque, near the four pulmonary veins (PVs). On average, 2.8+/-1.2 sites of rapid repetitive activities were identified per patient. They activated continuously, intermittently, or alternately during AF. The mean activation cycle length in the RA (196+/-22 msec) was significantly longer than that in the LA (179+/-26 msec; P = 0.004). The maximum dominant frequency in the LA was higher than that in the RA (6.41+/-1.18 Hz vs 5.66+/-0.55 Hz; P = 0.049). The maximum dominant frequency was consistently located in areas with rapid repetitive activations near the PVs.
Conclusion:
During human permanent AF associated with organic heart diseases, the activation cycle length was shorter in the LA posterior wall than in the RA free wall. Rapid repetitive activities are consistently observed in the LA posterior wall, at or near the PVs.