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Diagnostic implications of atrial vulnerability

T R Engel, J C Luck, C L Leddy

Pacing and Clinical Electrophysiology : PACE

|March 1, 1979

Summary

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Extrastimulation can induce atrial fibrillation or flutter (AFF) in vulnerable patients, even without prior diagnosis. This study demonstrates the extrastimulus technique

Area of Science:

Cardiology
Electrophysiology
Arrhythmology

Background:

Atrial fibrillation or flutter (AFF) can be triggered by extrastimulation in the atrial vulnerable zone.
The clinical significance of this atrial vulnerability is not well understood.

Purpose of the Study:

To investigate the clinical relevance of atrial vulnerability to AFF using extrastimulation.
To determine if the extrastimulus technique can reliably induce AFF in patients with and without documented paroxysms.

Main Methods:

Single, twice-threshold extrastimuli were applied at three right atrial sites in 45 unmedicated patients.
Patients were divided into Group I (documented AFF) and Group II (no documented AFF).
AFF induction was assessed during sinus rhythm and atrial pacing.

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Main Results:

AFF was successfully duplicated in 9 of 12 patients with documented AFF (Group I).
Atrial vulnerability to AFF was found in 12 of 33 patients without documented AFF (Group II).
The duration of induced AFF did not differ between groups; however, some vulnerable Group II patients experienced symptoms.

Conclusions:

The extrastimulus technique can effectively model and evaluate paroxysmal AFF when multiple atrial sites are stimulated.
Atrial vulnerability to extrastimulation may occur in patients suspected of atrial tachyarrhythmia, even without prior AFF diagnosis.
Atrial vulnerability does not appear to be a reliable indicator for diagnosing sinoatrial dysfunction.