Monitoring the Progression of the Atrial Electrical Remodeling in Patients With Paroxysmal Atrial Fibrillation. Analysis of the f-f Interval During Ambulatory ECG Monitoring.

Niwano, Shinichi; Wakisaka, Yoshinari; Kojima, Jisho; Yumoto, Yoshihiro; Inuo, Kimiatsu; Hara, Hideyuki; Saito, Junko; Niwano, Hiroe; Izumi, Tohru

doi:10.1253/circj.67.133

Cited by 25 publications

(21 citation statements)

References 23 publications

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“…10 A shortened FCL will favor transition to multiple reentry, which is a final common pathway irrespective of various initial mechanisms of AF. In the present study, pharmacological termination of long-lasting AF with bepridil alone or in combination with aprindine was preceded by a greater increase in FCL (190±39 ms) compared with electrical termination (150±29 ms).…”

Section: Termination Of Long-lasting Af and Maintenance Of Sinus Rhytmentioning

confidence: 99%

Maintenance of Sinus Rhythm and Recovery of Atrial Mechanical Function After Cardioversion With Bepridil or in Combination With Aprindine in Long-Lasting Persistent Atrial Fibrillation

Fujiki

Tsuneda

Sakabe

et al. 2004

Circ J

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harmacological termination by class I antiarrhythmic drugs is usually considered effective treatment for atrial fibrillation (AF) lasting only several days, but of little help for long-lasting AF. As AF progresses from paroxysmal to persistent, changes in the relative importance of AF mechanisms occur such as increasing substratemediated factors and decreasing triggering factors. Hence, in patients with long lasting AF, rhythm control therapy is abandoned and rate control therapy is selected as standard therapy. 1,2 However, we have previously demonstrated that oral administration of bepridil alone or in combination with aprindine restored sinus rhythm in 69% of 32 patients with long-lasting persistent AF (>3 months), 3 and we speculate that bepridil inhibits substrate-mediated factors and aprindine suppresses trigger-mediated factors. Bepridil hydrochloride, a diarylaminopropylamine derivative, was introduced as an anti-anginal agent. In addition to its Ca antagonist properties, it prolongs action potential duration and refractory periods of normal ventricular and atrial myocardium 4 by inhibiting several types of K current including rapid, slow and ultra rapid components of delayed rectifier K current. 5,6 Amiodarone has multi-channel blocking properties similar to bepridil and is effective in not only terminating long-lasting AF, but also maintaining sinus rhythm. 7 In a canine model of AF, amiodarone prevented down-regulation of the L-type Ca channel and increased fibrillation cycle length (FCL) through reversal of atrial remodeling. 8 In our previous study, termination of long-lasting AF with oral administration of bepridil was associated with a 30% increase in FCL, 2 and it is possible that bepridil is effective for not only termination of AF but also perpetuation of sinus rhythm. In the present study, we assessed the efficacy of pharmacological or electrical conversion in patients with long-lasting AF for recovery of atrial mechanical function and maintenance of sinus rhythm with respect to changes in FCL. Methods SubjectsAll 38 patients in the study group had had AF lasting at least 1 month, quantified by ECG, and the median was 5 months (range: 1-84 months). All patients underwent phys- Background The aim of this study was to evaluate pharmacological cardioversion of long-lasting persistent atrial fibrillation (AF) using bepridil in terms of recovery of atrial mechanical function and maintenance of sinus rhythm. Bepridil alone or in combination with aprindine is effective for termination of persistent AF. Methods and ResultsThe study group comprised 38 consecutive patients (24 men, 58.8±9.3 years) with successful conversion of persistent AF lasting >1 month either pharmacologically (Group I) or electrically (Group II). Fast Fourier transform analysis of fibrillation waves was performed and fibrillation cycle length (FCL) was calculated from the peak frequency. In Group I, sinus rhythm was pharmacologically restored in 22 patients after an average 30 days (7-49 days) of bepridil administration, either al...

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Section: Termination Of Long-lasting Af and Maintenance Of Sinus Rhytmentioning

confidence: 99%

Maintenance of Sinus Rhythm and Recovery of Atrial Mechanical Function After Cardioversion With Bepridil or in Combination With Aprindine in Long-Lasting Persistent Atrial Fibrillation

Fujiki

Tsuneda

Sakabe

et al. 2004

Circ J

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“…Even brief periods of atrial tachycardia can shorten the atrial effective refractory period (ERP), with loss of rate adaptation [1][2][3][4][5][6] and development of contractile abnormalities. 7,8 Several experimental and clinical studies have suggested that Ca overload plays a major role in the electrical and mechanical remodeling caused by prolonged rapid atrial excitation.…”

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confidence: 99%

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Kinebuchi

Mitamura

Shiroshita-Takeshita

et al. 2004

Circ J

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apid atrial excitation, as seen during atrial fibrillation (AF), modifies the electrophysiological and mechanical functions of the chamber, thereby promoting the perpetuation of arrhythmias and clot formation. Even brief periods of atrial tachycardia can shorten the atrial effective refractory period (ERP), with loss of rate adaptation 1-6 and development of contractile abnormalities. 7,8 Several experimental and clinical studies have suggested that Ca overload plays a major role in the electrical and mechanical remodeling caused by prolonged rapid atrial excitation. [9][10][11][12][13] Other studies have demonstrated that AF-induced electrical and mechanical dysfunction can be reduced by pretreatment with a Ca blocker, verapamil; 14-17 however, the long-term effects of verapamil on both electrical and mechanical remodeling remain controversial. We recently reported that atrial electrical remodeling is, to at least some degree, positively correlated with mechanical remodeling in a canine rapid atrial pacing model 18 and the purpose of the present study was to demonstrate whether verapamil can prevent both electrical and mechanical atrial remodeling in a canine rapid pacing model. Methods Animal PreparationThe study protocol was approved by the institutional scientific review committee. For this study, we used 16 adult mongrel dogs of either sex weighing 9-15 kg (average, 12 kg). The dogs were anesthetized with an intravenous injection of pentobarbital sodium (20 mg/kg iv) and ketamine chloride (15 mg/kg iv), then intubated and placed on mechanical ventilation with a volume-cycled ventilator (Model 607 Ventilator Harvard Apparatus). The heart was exposed via a right fifth intercostal thoracotomy and suspended in a pericardial cradle with continuous surface electrocardiographic (ECG) monitoring. A custom-designed set of electrodes, comprising a pair of electrodes with a distal hook for pacing and 2 pairs of electrodes with an interelectrode distance of 15 mm aligned proximally serving for recording, was sutured to the epicardial surface of the ridge of the right atrial appendage (RAA). Each pair of electrodes was positioned with interpolar distance of 2 mm. After closure of the thorax, the distal ends of these electrode leads were tunneled subcutaneously and exposed at the back, and then connected to a pacemaker (Nihon Kohden, output of 5 V with 0.7 ms pulse duration) in the jacket. The pacemaker was programmed to provide rapid atrial pacing at 400 ppm. This rate was maintained except for a brief period for measurement of electrophysiological and mechanical parameters. Following the surgical procedure, all dogs were administered oral antibiotics during the 5-day recovery period.

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“…Dynamics of cardiac excitation in PAF often change because even short periods of AF alter atrial function and structure [14,15]. Concomitant structural changes in the atrioventricular node additionally affect cardiac excitation [29,30].…”

Section: Discussionmentioning

confidence: 99%

“…Since even short-duration AF can induce electrical and contractile atrial remodeling, previous episodes of PAF may increase the variability of the atrial electrical wavelength also in the absence of fibrillation, i.e. during sinus rhythm [14,15]. This phenomenon may manifest as increased R-R interval dynamics on ECG.…”

Section: Introductionmentioning

confidence: 99%

Extended Electrocardiographic Poincare Analysis (EPA) for Better Identification of Patients with Paroxysmal Atrial Fibrillation

Duning¹,

Kirchhof²,

Wersching³

et al. 2011

J Clinic Experiment Cardiol

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Background: Atrial fibrillation (AF) -be it permanent or paroxysmal -is the most frequent and most effectively treatable cause of stroke. However, when paroxysmal, even electrocardiography for 24 hours (24h-ECG) misses AF in more than 50% of cases. We assessed whether extended Poincaré analysis of ECG R-R intervals (EPA) can help to identify electrocardiographic remodeling suggestive of paroxysmal AF (PAF). Methods:Twenty-nine patients with previously diagnosed PAF were re-assessed by 24h-ECG using conventional analysis and EPA based on a previously trained algorithm considering among other ratios of R-R interval duration, number of premature atrial complexes, approximate entropy, and standard deviation of Poincaré plots-axes. 24h-ECG from 21 healthy subjects without a history of AF served as negative, and 9 patients with permanent AF as positive controls.Results: PAF during 24h-ECG was detected in 4 out of 29 (14%) patients with a history of PAF by conventional analysis. EPA classified ECGs of these and 22 additional patients with a history of PAF, i.e. a total 90%, as suggestive of PAF. All patients with permanent AF were identified by both tools. EPA additionally classified the ECG in 4 out of 21 control subjects as suggestive of PAF.Conclusions: Extended Poincaré analysis in patients with a history of PAF is more sensitive to electrocardiographic abnormalities than is conventional 24h-ECG analysis. These findings warrant prospective studies of EPA in patients with a high likelihood of PAF, i.e. with stroke of undetermined origin.

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Monitoring the Progression of the Atrial Electrical Remodeling in Patients With Paroxysmal Atrial Fibrillation. Analysis of the f-f Interval During Ambulatory ECG Monitoring.

Cited by 25 publications

References 23 publications

Maintenance of Sinus Rhythm and Recovery of Atrial Mechanical Function After Cardioversion With Bepridil or in Combination With Aprindine in Long-Lasting Persistent Atrial Fibrillation

Maintenance of Sinus Rhythm and Recovery of Atrial Mechanical Function After Cardioversion With Bepridil or in Combination With Aprindine in Long-Lasting Persistent Atrial Fibrillation

Oral Verapamil Attenuates the Progression of Pacing-Induced Electrical and Mechanical Remodeling of the Atrium

Extended Electrocardiographic Poincare Analysis (EPA) for Better Identification of Patients with Paroxysmal Atrial Fibrillation

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