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Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Annejet Heida1, Mathijs S van Schie1, Willemijn F B van der Does1

  • 1Erasmus Medical Center, Department of Cardiology, 3015 GD Rotterdam, The Netherlands.

Journal of Clinical Medicine
|July 2, 2021
PubMed

Insights

Atrial fibrillation (AF) did not significantly alter overall atrial conduction velocity (CV). However, Bachmann's bundle showed reduced CV in AF patients, suggesting it may be a key site for AF development.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Physics

Background:

  • Atrial fibrillation (AF) is a common arrhythmia with complex mechanisms.
  • Intra-atrial conduction velocity (CV) and its heterogeneities are crucial in AF pathophysiology.
  • The impact of AF episodes on CV and regional differences during sinus rhythm remain unclear.

Purpose of the Study:

  • To compare intra-atrial CV between patients with and without AF.
  • To investigate regional CV heterogeneities within the atria during sinus rhythm.
  • To identify potential substrate modifications associated with AF.

Main Methods:

  • Case-control study involving 34 patients undergoing intra-operative epicardial mapping.
  • Mapping covered the right atrium (RA), Bachmann's bundle (BB), left atrium (LA), and pulmonary vein area (PVA).
  • CV vectors, total activation times (TAT), and unipolar voltages were analyzed.

Main Results:

  • Biatrial median CV did not differ between groups (AF: 90±8 cm/s vs. non-AF: 92±6 cm/s, p=0.56).
  • Bachmann's bundle (BB) showed significantly reduced CV in AF patients (79±12 cm/s vs. 88±11 cm/s, p=0.02).
  • In AF patients, BB was the predilection site for lowest CV (53%), associated with prolonged TAT and decreased voltages.

Conclusions:

  • Overall biatrial CV is preserved in patients with a history of AF.
  • Bachmann's bundle demonstrates reduced conduction velocity and heterogeneity in AF patients.
  • BB may represent a critical substrate for AF initiation and maintenance.

Keywords:
atrial fibrillationatrial remodelingconduction velocityelectrophysiology

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