Electrophysiological Characteristics of the Human Atria After Cardioversion of Persistent Atrial Fibrillation

Author:

Pandozi Claudio1,Bianconi Leopoldo1,Villani Mauro1,Gentilucci Giuseppe1,Castro Antonio1,Altamura Giuliano1,Jesi Anna P.1,Lamberti Filippo1,Ammirati Fabrizio1,Santini Massimo1

Affiliation:

1. From the Department of Cardiology, San Filippo Neri Hospital, Arrhythmia Control Unit (M.V.), La Sapienza University, Rome, Italy.

Abstract

Background —In animal models, induced atrial fibrillation shortens the atrial effective refractory period (ERP) and reverses its physiological adaptation to rate. It is not clear whether this process, known as “electrical remodeling,” occurs in humans. Methods and Results —We determined the ERPs, at 5 pacing cycle lengths (300 to 700 ms) and in 5 right atrial sites, after internal cardioversion of chronic atrial fibrillation in 25 patients (14 in pharmacological washout and 11 on amiodarone). The ERPs were 195.5±18.8 ms in the washout and 206.3±17.9 ms in the amiodarone patients ( P <0.0001). ERPs were closely correlated with the stimulation rates ( r =0.95 in the washout and r =0.94 in the amiodarone group), and slope values indicating a normal (≥0.07) or nearly normal (0.05 to 0.06) adaptation of ERP to rate were found in 77% of the 84 paced sites. The mean ERP was shorter in the lateral wall (198.1±17.9 ms) than in the atrial roof (203.3±21.5 ms) and in the septum (210.5±20.0 ms) ( P <0.03). After 4 weeks of sinus rhythm, the mean ERP, determined again in 8 patients (4 in wash-out and 4 on amiodarone), was significantly increased compared with the basal study (221.4±21.4 versus 197.8±18.3 ms, P <0.0001). Conclusions —After cardioversion of chronic atrial fibrillation, (1) atrial ERP adaptation to rate was normal or nearly normal in the majority of the cases, (2) a significant dispersion of refractoriness between different right atrial sites was present, and (3) ERPs were significantly increased after 4 weeks of sinus rhythm in both washout and amiodarone patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference32 articles.

1. Allessie MA Lammers WJEP Bonke FIM Hollen J. Experimental evaluation of Moe’s multiple wavelet hypothesis of AF. In: Zipes DP Jalife J eds. Cardiac Electrophysiology and Arrhythmias . Orlando Fla: Grune & Stratton; 1985:265–275.

2. Allessie MA Lammers WJEP Rensma PL Bonke FIM. Flutter and fibrillation in experimental modes: what has been learned that can be applied to humans. In: Brugada P Wellens HJJ eds. Cardiac Arrhythmias: Where to Go From Here . Mount Kisco NY: Futura Publishing Co; 1987:67–82.

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