Wavelength Index at Three Atrial Sites in Patients with Paroxysmal Atrial Fibrillation (original) (raw)
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Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
Atrial electrical remodeling plays a part in recurrence of atrial fibrillation (AF). It has been related to an increase in heterogeneity of atrial refractoriness that facilitates the occurrence of multiple reentry wavelets and vulnerability to AF. To examine the relationship between dispersion of atrial refractoriness (Disp_A) and vulnerability to AF induction (A_Vuln) in patients with clinical paroxysmal AF (PAF). Thirty-six patients (22 male; age 55+/-13 years) with > or =1 year of history of PAF (no underlying structural heart disease--n=20, systemic hypertension--n=14, mitral valve prolapse--n=1, surgically corrected pulmonary stenosis--n=1), underwent electrophysiological study (EPS) while off medication. The atrial effective refractory period (AERP) was assessed at five different sites--high (HRA) and low (LRA) lateral right atrium, high interatrial septum (IAS), proximal (pCS) and distal (dCS) coronary sinus--during a cycle length of 600 ms. AERP was taken as the longest S...
Pacing and Clinical Electrophysiology, 2009
Background: Shortening of the atrial refractory period is the key feature of atrial electrical remodeling during atrial fibrillation (AF). During sinus rhythm (SR), assessment of the atrial refractoriness is hampered by the fact that the atrial repolarization wave (Ta wave) is largely obscured by the following QRST complex. The purpose of this study was to study the Ta wave in subjects with paroxysmal AF during SR with thirddegree atrioventricular (AV) block, and in matched controls.
Journal of Electrocardiology, 2002
This article studies the role of dispersion of atrial refractoriness (DAR) in the genesis of atrial fibrillation (AF). A 20-polar Halo catheter or a 40-polar basket catheter was placed in the right atrium and a 10-polar catheter in the coronary sinus in 21 patients with paroxysmal AF. Bipolar electrograms during AF were recorded from 7 to 16 sites in both atria. As control, electrograms during AF induced by extra-stimulation or burst pacing were also recorded from 4 to 14 sites in both atria in 12 patients with supraventricular tachycardias but without history of AF. The local atrial fibrillation intervals (AFI) during a period of 10 s or 20 s were measured and the mean, median and the 5th, 10th and 15th percentile AFIs at each site were calculated as estimates of the local effective refractory period (AERP). The maximum dispersion and variance of the estimated AERP among the 7-16/4-14 sites were used as measures of the DAR. The maximum dispersion and variance of the 5th and 10th percentile AFIs were significantly greater in the AF group than those in the control group, which were mainly due to the shortening of the minimum 5th and 10th percentile AFIs. No significant differences in dispersion and variance of the mean and median AFIs were shown between the 2 groups. The dispersion and variance of atrial refractoriness during AF estimated from the measurement of short AFIs were significantly greater in patients with paroxysmal AF than in those without clinical AF. The increased dispersion of refractoriness in patients with AF was mainly due to the shortening of the minimum AFIs. These findings suggest the involvement of an increased dispersion of atrial refractoriness in the genesis of paroxysmal AF.
Frequency Analysis in Different Types of Paroxysmal Atrial Fibrillation
Journal of the American College of Cardiology, 2006
This study sought to investigate the regional frequency distribution from multiple bi-atrial sites in different types of paroxysmal atrial fibrillation (AF). BACKGROUND A previous study showed a left atrium (LA) to right atrium (RA) frequency gradient in patients with paroxysmal AF. METHODS Forty-four patients (age ϭ 60 Ϯ 16, male patients ϭ 27) with paroxysmal AF originating from the pulmonary veins (PVs) (n ϭ 31) or superior vena cava (SVC) (n ϭ 13) were included. Frequency analysis was performed on the intracardiac electrograms (7 s, 1 kHz/channel) recorded from PV, posterior LA, coronary sinus (CS), posterolateral RA, and SVC. The largest peak frequency was identified as the dominant frequency (DF). RESULTS In the PV-AF patients, there was a frequency gradient from the PV ostium to the LA, RA, and SVC (8.5 Ϯ 3.3 Hz vs. 5.9 Ϯ 1.1 Hz vs. 5.2 Ϯ 0.85 Hz vs. 5.5 Ϯ 0.48 Hz, respectively, p Ͻ 0.001). The highest DFs were mostly located at the arrhythmogenic PV ostium (58%). The DFs of the arrhythmogenic PV and PV ostium were significantly higher than those of the non-arrhythmogenic PVs and PV ostia (p Ͻ 0.05). In the SVC-AF patients, there was a frequency gradient from the SVC to the RA, LA, and PV (8.0 Ϯ 2.4 Hz vs. 5.9 Ϯ 1.1 Hz vs. 5.9 Ϯ 0.7 Hz vs. 5.8 Ϯ 0.7 Hz, respectively, p ϭ 0.001). The highest DFs were mostly located inside the SVC (77%) instead of the SVC ostium (as compared with PV-AF patients, p ϭ 0.035). CONCLUSIONS The location of the highest DF depended on the arrhythmogenic PV or SVC. A frequency gradient was present between the arrhythmogenic thoracic vein and atrium in all patients.
Initiating mechanisms of paroxysmal atrial fibrillation
Europace, 2003
The understanding of the onset mechanisms of paroxysmal atrial fibrillation (AF) may help to develop preventive therapy. Specific heart rate (HR) patterns and autonomic changes immediately before the onset of paroxysmal AF are not fully investigated. We undertook the present study to assess HR and heart rate variability (HRV) changes before the onset of AF using 24-h Holter electrocardiographic analysis in patients without antiarrhythmic medication. In 27 patients, 48 episodes of AF, lasting more than 30s and preceded by sinus rhythm for more than 1h were analysed. The hour preceding AF was divided in 5- and 30 min blocks. HR was also analysed in the last 15 beats. In 21% of the episodes, HR decreased >or=5% in the last 5 min (defined as deceleration); it increased >or=5% in 37% (defined as acceleration). HR, standard deviation (SD) and SD corrected for RR interval changed significantly in the last 5 min in the total group. Acceleration and deceleration were already visible over 30-min blocks in both these subgroups; changes in SD were only seen in the accelerators. The number of atrial premature beats (PACs) increased before AF, most clearly in the accelerators. Spectral HRV analysis revealed no additional information. Changes in HR, SD, and an increased number of PACs herald AF from at least 30 min before onset, more pronounced in accelerators. Spectral HRV parameters are not useful to foresee AF onset. This has possible implications for device therapy.
Susceptibility to paroxysmal atrial fibrillation: A study using sinus rhythm P wave parameters
2010 Computing in Cardiology, 2010
Early recognition of patients at high risk for atrial fibrillation may help to minimize potential health risks. The detection of susceptibility to develop atrial fibrillation is thus a real clinical challenge. Whereas many studies have used the signal-averaged P wave, the aim of this work is to determine whether electrocardiographic parameters resulting from the analysis of the P wave in ECG recorded during sinus rhythm could be markers for paroxysmal atrial fibrillation susceptibility. Our idea was to compare the ECG in sinus rhythm from two populations: healthy people and patients subject to paroxysmal atrial fibrillation. In addition to standard P wave parameters (P width, P-R interval,.. .), the Euclidean distance between beat-to-beat P waves, which has been rarely addressed in this context, was studied on lead V1. Significant differences between the healthy and the paroxysmal atrial fibrillation groups were obtained for various parameters. Moreover, a classification of the two groups based on the joint analysis of P width and P-R interval was suggested. This proposed classification could lead to an effective identification of patients at risk to develop atrial fibrillation.
Journal of Electrocardiology, 2012
Purpose: This study aims to develop a noninvasive atrial remodeling index (RI) to separate patients presenting paroxysmal atrial fibrillation (ParAF) from those with sustained persistent atrial fibrillation (PerAF), that is, AF episodes interrupted 7 days or more after the onset. Methods: Signal-averaged P-wave duration (SAPWd) and left atrial anteroposterior diameter (LADd) were measured in 33 ParAF patients, in 26 sustained PerAF patients, and in 18 control subjects. By using SAPWd and LADd, a dichotomous (0/1) RI was created. A logistic regression model on the probability of having a sustained PerAF vs a ParAF episode was estimated, including the RI, sex, age, and cardiac comorbidities as covariates. Results: Signal-averaged P-wave duration was significantly longer in sustained PerAF (153 ± 15 milliseconds) than in ParAF patients (142 ± 13 milliseconds, P b .001) and in both ParAF and sustained PerAF groups vs control group (123 ± 7 milliseconds, P b .001). Left atrial anteroposterior diameter was larger both in sustained PerAF (43 ± 6 mm) vs ParAF patients (38 ± 5 mm, P = .002) and in sustained PerAF group vs control group (38 ± 2 mm, P = .004), but no differences were observed between ParAF patients and controls (P = .6). A 12-fold increase (odds ratio, 11.8; 95% confidence interval, 2.2-63.5) in the odds of having a sustained PerAF vs a ParAF episode was observed in patients with RI equal to 1. Conclusions: P-wave duration and left atrium diameter enabled to define a noninvasive atrial RI to separate patients with ParAF from those with sustained PerAF. This could be a useful tool to select a suitable strategy for AF treatment.
2019
Objectives – The aim of this study was to determine if specifi c electrocardiographic parameters and echocardiographic atrial indices could help in predicting the risk for developing paroxysmal atrial fi brillation (PAF). Study population – 49 patients (mean age of 64.4 ± 9.6 years, 53% women) with a history of PAF and without any cardiac structural disease, were evaluated by ECG and standard bidimensional echocardiography. P wave duration, amplitude and dispersion (Pd) were calculated from ECG and left and right atrial diameters, area, volumes, atrial emptying function and atrial function index were assessed by 2D echocardiography. Results – Compared with the control group, in the PAF patients group they had signifi cantly larger anterior-posterior LA diameter (39±14 mm vs 33±3 mm, p<0.0001), area (22±4 cm2 vs 17±2 cm2, p<0.0001), left atrial indexed volume (70±15 ml vs 50±11 ml, p<0.0001) and electric parameters Pmin, Pd and Pa DII (47.4±4 ms vs 64.3±12.2 ms, 51.9±12 ms v...
Frequency spectrum correlation along atria to study atrial fibrillation recurrence
Computing in Cardiology 2014, 2014
Atrial fibrillation (AF) is an abnormal heart rhythm originated in the top chambers of the heart. The goal of pulmonary vein ablation for AF is regaining a normal heart rhythm; nevertheless restoration sinus rhythm is difficult to prognostic. Frequency spectrum was calculated from electrical activity registered along all the atria. We investigate whether there were differences between atrial electrical activity spectrum from both atria in recurrent and non-recurrent AF groups. The database includes intracardiac recordings from 43 paroxysmal and persistent AF patients submitted to an ablation procedure. All patients were monitored after ablation, and were divided in 2 groups according to AF recurrence outcome: 26 of them remained in sinus rhythm, whereas the other 17 turned back to AF. Results showed a stronger correlation between atrial activity frequency spectrum from dipoles located in the left atrium and in the right atrium in the non-recurrent group than in the recurrent AF group. In addition, statistical significant differences were found between atrial activity frequency spectrum correlation between dipoles located in the left and right atria in the non-recurrent and recurrent AF groups. These findings show the more regular atrial activity along the atria in the patients with nonrecurrences in AF.