Abnormal pattern of left atrial activation and asynchronous conduction predicted the occurrence of new atrial fibrillation: evidences for Bachmann’s bundle block in atrial fibrillation pathophysiology

Author:

Seewöster Timm1ORCID,Marinov Kaloyan1ORCID,Löbe Susanne1,Knopp Helge1,Nedios Sotirios2,Bollmann Andreas1ORCID,Hindricks Gerhard1ORCID,Dinov Borislav1

Affiliation:

1. Department of Electrophysiology, HELIOS Kliniken GmbH, Heart Center Leipzig—University Hospital of Cardiology, Struempellstr. 39, 04289 Leipzig, Germany

2. Department of Electrophysiology, HELIOS Kliniken GmbH, Heart Center Leipzig

Abstract

Abstract Aims Evidences suggest that recurrent atrial fibrillation (AF) is associated with left atrial (LA) remodelling. The goal of this study is to establish a method for assessment of LA remodelling and find predictors for the development of AF. Methods and results This prospective study included patients without a history of AF who were evaluated using pulsed-wave tissue Doppler imaging (PW-TDI). P-wave onset to A′-wave (PA′ interval) was measured at the septal, lateral, anterior, and inferior mitral annulus. Abnormal LA activation pattern was defined as an upward LA activation over the coronary sinus and delayed activation anterior. Left atrial asynchrony was measured as (i) the difference between the septal and lateral PA′ interval (DLS) and (ii) the standard deviation of all four PA′ intervals (SD4-PA′). The follow-up for AF recurrence (AF+) was based on symptoms and 7-day Holter electrocardiograms. Ninety-eight patients (mean age 58 ± 15 years, 47% female) were included. During a follow-up of 28 ± 9 months, AF was documented in 10%. More pronounced LA asynchrony was observed in AF+ group: DLS (AF+) 39 ± 16 vs. DLS (AF−) 20 ± 11 ms; P < 0.001, and SD4-PA′ (AF+) 18.6 ± 6.4 vs. SD4-PA′ (AF−) 11.7 ± 4.2 ms; P < 0.001. Abnormal LA activation was frequently observed in AF+ patients: 60% vs. 27%; P = 0.033. Electrocardiogram sign of Bachmann’s bundle block (BBB) was associated with prolongation of SD4-PA′: SD4-PA′ (BBB+) vs. SD4-PA′ (BBB−) = 18 ± 6 vs. 13 ± 4.5 ms; P = 0.007. Conclusions More pronounced LA asynchrony and abnormal LA activation pattern were associated with new-onset AF.

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference23 articles.

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