Clinical Significance of the Atrial Fibrillation Threshold in Patients with Paroxysmal Atrial Fibrillation

Inoue, Kentaro; Shirayama, Takeshi; Shiraishi, Hiroaki; Matoba, Yayoi; Imai, Hiroto; Inoue, Daisuke; Nakagawa, Masao

doi:10.1046/j.1460-9592.2001.00796.x

Cited by 8 publications

(17 citation statements)

References 25 publications

(39 reference statements)

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“…5,19) On the other hand, no significant changes have been reported in the refractory period of diseased atrium. 7,20) We found no significant difference in the right atrial effective refractory period between patients with and without inducible atrial fibrillation, which is consistent with the latter results. A positive correlation existed between the right atrial effective refractory period and age in this study, and the right atrial effective refractory period became longer as age increased.…”

Section: Patient Characteristicssupporting

confidence: 91%

“…Although the effects of the underlying diseases on atrial vulnerability might not be negligible, this is a limitation common to many studies. 7,14,16) In this study, we found no difference with respect to age between patients with and without inducible atrial fibrillation, which is not concordant with previous reports. 1,2) The reason for this discrepancy might be due to the underlying arrhythmias.…”

Section: Patient Characteristicscontrasting

confidence: 60%

“…The maximum width of A2 was, therefore, obtained at the shortest S1-S2 interval that could provoke A2. 7,[10][11][12][13] 2) Right atrial effective refractory period: Right atrial effective refractory period was defined as "the longest S1-S2 interval that does not provoke A2 in the high right atrium". 10,[13][14][15] 3) Wavelength index: Wavelength index was defined as "the ratio of effective refractory period / maximum width of A2".…”

Section: ) Percent Maximum Atrial Fragmentationmentioning

confidence: 99%

“…Although several parameters, such as the atrial refractory period, fragmented atrial activity, atrial conduction delay, repetitive atrial firing, wavelength index, and inducibility of atrial fibrillation have been proposed as indices of atrial vulnerability, it remains uncertain whether these indices also represent inherent electrophysiologic properties in elderly people without atrial fibrillation. [5][6][7][10][11][12][13][14][15][16][17] The percent maximum atrial fragmentation has been reported to reflect prolongation of the atrial electrogram, the presence of a conduction abnormality, or the occurrence of atrial fibrillation. 13) In this study, the percent maximum atrial fragmentation was greater in patients with inducible atrial fibrillation than in those without inducible atrial fibrillation, which is concordant with previous reports.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…3,4) Previous studies have shown that a short refractory period, conduction delay, and inducibility of atrial fibrillation characterize patients with paroxysmal atrial fibrillation, [5][6][7] but it remains unclear whether these indices merely represent the electrophysiologic nature of elderly people, irrespective of whether they have atrial fibrillation.…”

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confidence: 99%

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Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

et al. 2003

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SUMMARYAlthough atrial fibrillation is a common arrhythmia, especially in the elderly, little is known about age-related changes in the electrophysiologic properties of the atrium. The aim of this study was to analyze the effect of aging on atrial vulnerability to atrial fibrillation.An electrophysiologic study was performed in 45 patients with no history of atrial fibrillation, Wolff-Parkinson-White syndrome, structural heart disease, or conditions with potential effects on cardiac hemodynamic or electrophysiologic function (15 females; mean age, 52 ± 18 years; range, 14 to 84 years). The following atrial excitability parameters were assessed: spontaneous or paced (A1) and extrastimulated (A2) atrial electrogram widths, percent maximum atrial fragmentation (A2/A1 × 100), effective refractory period, wavelength index (ERP/A2), and inducibility of atrial fibrillation.Atrial fibrillation was induced in 9 patients. Percent maximum atrial fragmentation was greater (176 ± 36 vs 137 ± 26%, P < 0.001) and wavelength index was shorter (2.4 ± 0.4 vs 3.2 ± 0.9, P < 0.01) in the patients with than without inducible atrial fibrillation.However, age was similar in patients with and without inducible atrial fibrillation (47 ± 11 vs 53 ± 19 years, P = 0.36). Percent maximum atrial fragmentation and effective refractory period directly correlated with age (r = 0.32, P < 0.05 and r = 0.45, P < 0.001, respectively). On the other hand, wavelength index (3.1 ± 0.9) did not correlate with age (r = -0.05, P = 0.77).This study suggests that the mechanism triggering atrial fibrillation may be very well different between older and younger patients with atrial fibrillation, because younger patients have no marked substrate for atrial fibrillation. (Jpn Heart J 2003; 44: 385-393)

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Section: Patient Characteristicssupporting

confidence: 91%

Section: Patient Characteristicscontrasting

confidence: 60%

Section: ) Percent Maximum Atrial Fragmentationmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

et al. 2003

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Atrial electrophysiologic abnormalities in patients with wolff‐parkinson‐white syndrome but without paroxysmal atrial fibrillation

Sakabe

Fukuda

Nada

et al. 2004

Clinical Cardiology

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SummaryBackground: Paroxysmal atrial fibrillation (PAF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome.Hypothesis: The purpose of this study was to analyze the atrial electrophysiologic abnormalities and vulnerability to develop atrial fibrillation (AF) in patients with WPW syndrome but with no previous history of PAF.Methods: We investigated atrial electrophysiologic abnormalities and vulnerability to AF in patients with WPW syndrome but without PAF. An electrophysiologic study was performed in 28 patients with WPW syndrome, 23 with atrioventricular nodal reentrant tachycardia (AVNRT) and 25 with other arrhythmias (control), all of whom had no history of PAF. The following atrial excitability parameters were assessed: effective refractory period (ERP), spontaneous or paced (A1) and extrastimulated (A2) atrial electrogram widths, percent maximum atrial fragmentation (%MAF; A2/A1 ϫ 100), wavelength index (WLI; ERP/A2), and inducibility of AF.Results: The ERP tended to be shorter in patients with WPW syndrome and in those with AVNRT than in the control group. The %MAF increased (154 ± 33 vs. 137 ± 23%, p < 0.05) and WLI decreased (2.7 ± 0.8 vs. 3.4 ± 1.0, p < 0.05) significantly in patients with WPW syndrome compared with the control group; however, these parameters in patients with AVNRT showed intermediate values. Atrial fibrillation was more in-

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Relation of Age and Sex to Atrial Electrophysiological Properties in Patients with No History of Atrial Fibrillation

Sakabe

Fukuda

Soeki

et al. 2003

Pacing Clinical Electrophis

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Although atrial fibrillation is a common arrhythmia, especially in elderly men, little is known about age related changes in atrial electrophysiological properties or gender differences. The aim of this study was to analyze the effects of aging on vulnerability to atrial fibrillation and assessed gender differences in those age related changes. An electrophysiological study was performed on 73 patients with no history of atrial fibrillation, structural heart disease, or conditions with potential effects on cardiac hemodynamic or electrophysiological function, including 25 women (mean age 49 +/- 18 years; range 12-84 years). The following atrial excitability parameters were assessed: spontaneous or paced (A1) and extrastimulated (A2) atrial electrogram widths, percent maximum atrial fragmentation (A2/A1 x 100), effective refractory period, wavelength index (effective refractory period/A2), and inducibility of atrial fibrillation. There were no significant differences in percent maximum atrial fragmentation (143 +/- 28 vs 142 +/- 35%), effective refractory period (241 +/- 39 vs 238 +/- 50 ms), wavelength index (2.9 +/- 0.8 vs 3.1 +/- 0.9), induction of atrial fibrillation (10 [21%] vs 7 [28%]), or age (50 +/- 17 vs 49 +/- 20 years) between men and women. Age was not statistically different between those patients with and without induction of atrial fibrillation in men (48 +/- 14 vs 50 +/- 18 years) and women (48 +/- 18 vs 49 +/- 21 years). Percent maximum atrial fragmentation and effective refractory period were directly correlated with age in men (r = 0.35, P = 0.01; r = 0.46, P< 0.001, respectively) and women (r = 0.42, P = 0.04; r = 0.45, P = 0.02, respectively), though wavelength index did not correlate with age in men (r = -0.04) or women (r = -0.04) with no history of atrial fibrillation. Considering these findings, the authors conclude that the mechanism triggering atrial fibrillation may be different between older and younger patients with atrial fibrillation, because younger patients who have no marked substrate for atrial fibrillation may need many trigger beats to induce atrial fibrillation.

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Clinical Significance of the Atrial Fibrillation Threshold in Patients with Paroxysmal Atrial Fibrillation

Cited by 8 publications

References 25 publications

Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

Atrial electrophysiologic abnormalities in patients with wolff‐parkinson‐white syndrome but without paroxysmal atrial fibrillation

Relation of Age and Sex to Atrial Electrophysiological Properties in Patients with No History of Atrial Fibrillation

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