Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation

Tai, Ching‐Tai; Chen, Shih‐Ann; Tzeng, Jyh-Woei; Kuo, Benjamin Ing Tiau; Ding, Yu‐An; Chang, Mau‐Song; Shyu, Liang-Yu

doi:10.1016/s0735-1097(01)01215-3

Cited by 36 publications

(22 citation statements)

References 24 publications

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“…Also, fragmented atrial activity was identified in more patients with PAF than in control patients. These findings are consistent with previous studies who demonstrated greater delays in intra-atrial or inter-atrial conduction, and a higher incidence of atrial fragmentation in patients with PAF [6,[20][21][22]. In fact, the presence of marked conduction delay during an atrial premature beat with a short coupling interval, combined with longer and fractionated electrograms is an important electrophysiological finding, compatible with the necessary conditions for the occurrence and maintenance of local reentry circuits.…”

Section: Discussionsupporting

confidence: 92%

Effects of acute autonomic modulation on atrial conduction delay and local electrograms duration in paroxysmal atrial fibrillation

Oliveira¹,

Silva²,

Cunha³

et al. 2011

International Journal of Cardiology

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Slowed atrial conduction may contribute to reentry circuits and vulnerability for atrial fibrillation (AF). The autonomic nervous system (ANS) has modulating effects on electrophysiological properties. However, complex interactions of the ANS with the arrhythmogenic substrate make it difficult to understand the mechanisms underlying induction and maintenance of AF. Aim: To determine the effect of acute ANS modulation in atrial activation times in patients (P) with paroxysmal AF (PAF). Methods and results: 16P (9 men; 59 ± 14 years) with PAF, who underwent electrophysiological study before AF ablation, and 15P (7 men; 58 ± 11 years) with atrioventricular nodal reentry tachycardia, without documentation or induction of AF (control group). Each group included 7P with arterial hypertension but without underlying structural heart disease. The study was performed while off drugs. Multipolar catheters were placed at the high right atrium (HRA), right atrial appendage (RAA), coronary sinus (CS) and His bundle area (His). At baseline and with HRA pacing (600 ms, shortest propagated S2) we measured: i) intraatrial conduction time (IACT, between RAA and atrial deflection in the distal His), ii) inter-atrial conduction time (interACT, between RAA and distal CS), iii) left atrial activation time (LAAT, between atrial deflection in the distal His and distal CS), iv) bipolar electrogram duration at four atrial sites (RAA, His, proximal and distal CS). In the PAF group, measurements were also determined during handgrip and carotid sinus massage (CSM), and after pharmacological blockade of the ANS (ANSB). AF was induced by HRA programmed stimulation in 56% (self-limited -6; sustained -3), 68.8% (self-limited -6; sustained -5), and 50% (selflimited -5; sustained -3) of the P, in basal, during ANS maneuvers, and after ANSB, respectively (p = NS). IACT, interACT and LAAT significantly lengthened during HRA pacing in both groups (600 ms, S2). P with PAF have longer IACT (p b 0.05), a higher increase in both IACT, interACT (p b 0.01) and electrograms duration (p b 0.05) with S2, and more fragmented activity, compared with the control group. Atrial conduction times and electrograms duration were not significantly changed during ANS stimulation. Nevertheless, ANS maneuvers increased heterogeneity of the local electrograms duration. Also, P with sustained AF showed longer interACT and LAAT during CSM. Conclusion: Atrial conduction times, electrograms duration and fractionated activity are increased in PAF, suggesting a role for conduction delays in the arrhythmogenic substrate. Acute vagal stimulation is associated with prolonged interACT and LAAT in P with inducible sustained AF and ANS modulation may influence the heterogeneity of atrial electrograms duration.

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Section: Discussionsupporting

confidence: 92%

Effects of acute autonomic modulation on atrial conduction delay and local electrograms duration in paroxysmal atrial fibrillation

Oliveira¹,

Silva²,

Cunha³

et al. 2011

International Journal of Cardiology

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“…94 Thus, AF seems to cause a variety of alterations in the atrial architecture and function that contribute to remodeling and perpetuation of the arrhythmia. Despite these pathological changes in the atria, however, isolation of the pulmonary veins (PVs) will prevent AF in many such patients with paroxysmal AF.…”

Section: Atrial Pathology As a Cause Of Atrial Fibrillationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,876

589

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“…Local atrial complement activation, oxidative stress and reduced blood flow then all contribute to the development of tissue injury and fibrosis resulting atrial remodeling (34). The ensuing loss of atrial myocardial mass as well as the manifestation of structural heterogeneity of the atrial myocardium may account for the intra-atrial conduction disturbances and dispersion of the atrial refractory period providing the electrophysiological substrate for the development of AF (35).…”

Section: Discussionmentioning

confidence: 99%

Association between C-reactive protein, carotid intima-media thickness and P-wave dispersion in obese premenopausal women: an observational study

Özuğuz

Ergün²,

Işık³

et al. 2012

Anadolu Kardiyol Derg

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Association between C-reactive protein, carotid intima-media thickness and P-wave dispersion in obese premenopausal women: an observational studyPremenapozal şişman kadınlarda P dalga dispersiyonu karotis intima-media kalınlığı ve C-reaktif protein arasındaki ilişki; Gözlemsel bir çalışma Original Investigation Özgün Araşt›rma ABSTRACTObjective: The aim of the present study was to evaluate P-wave dispersion (PWD) in obese women, and to investigate the relationship between P-wave measurements, high sensitive C-reactive protein (hsCRP), carotid intima-media thickness (CIMT) and echocardiographic findings. Methods: Forty-four patients with obese premenopausal women and 30 females with normal weight were enrolled this cross sectional, observational study. Results of anthropometric measurements, laboratory assays, electrocardiographic and echocardiographic findings were recorded for each participant. Student t, Mann-Whitney U and Pearson Chi-square tests, and Spearman correlation analysis were used for statistical analysis. Multiple regression analysis was used to identify independent factors associated with PWD development.Results: The obese group had significantly higher values for PWD (41.8±11.8 ms vs. 28.5±9.3 ms; p<0.001) as well as for P max (105.2±14.3 ms vs. 89.0±13.3 ms; p<0.001). Correlation analyses revealed the presence of a positive correlation between PWD and each of insulin, systolic blood pressure, diastolic blood pressure, hsCRP, CIMT, left atrial diameter (LAD), waist circumference, waist to hip ratio and body mass index in obese participants. The only significant association that was observed on multiple linear regression analysis, after adjustments for confounding risk factors, was between LAD and PWD (β=4.290, 95% CI: 1.870-9.720, p=0.032). Conclusion:We found that increased PWD values in obese patients are correlated positively with hsCRP, CIMT and abdominal obesity. However, independent and significant association was found only between LAD and PWD.(Anadolu Kardiyol Derg 2012; 12: 40-6) Key words: Obesity, subclinical inflammation, P-wave dispersion, atherosclerosis, regression analysis 40ÖZET Amaç: Çalışmamızın amacı, premenapozal obez kadınlarda P dalga dispersiyonunun incelenmesi, P dalga ölçümleri ile yüksek duyarlılıklı C-reaktif protein (hsCRP), karotis intima-media kalınlığı (KIMK) ve ekokardiyografi bulguları arasındaki ilişkilerin değerlendirilmesidir.Yöntemler: Kırk dört premenapozal obez kadın ve 30 normal kilolu, sağlıklı, gönüllü, kesitsel gözlemsel çalışmaya dahil edildi. Tüm katılımcılarda, antropometrik ölçümlerden sonra açlık kan şekeri, insülin düzeyi, insülin direnci (HOMA-IR), hsCRP, lipit parametreleri ve KIMK ölçüldü, elektrokardiyografik ve ekokardiyografik parametreler değerlendirildi. İstatistiksel analizde Student t, Mann-Whitney U ve Pearson Ki-kare testleri, ve Spearman korelasyonu analizi kullanıldı. Çoklu doğrusal regresyon analizi ile P dalga dispersiyonu gelişimini etkileyen bağımsız belirleyicileri araştırıldı. Bulgular: Premenapozal obez kadınlar ile sağlıklı ...

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Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation

Abstract: Increased delays in the individual potential of the fractionated atrial electrograms may be related to the development of AFL and AF.

Cited by 36 publications

References 24 publications

Effects of acute autonomic modulation on atrial conduction delay and local electrograms duration in paroxysmal atrial fibrillation

Effects of acute autonomic modulation on atrial conduction delay and local electrograms duration in paroxysmal atrial fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Association between C-reactive protein, carotid intima-media thickness and P-wave dispersion in obese premenopausal women: an observational study

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