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Ramdat Misier NL, Amesz JH, Taverne YJHJ, Nguyen H, van Schie MS, Knops P, Schinkel AFL, de Jong PL, Brundel BJJM, de Groot NMS. Biatrial arrhythmogenic substrate in patients with hypertrophic obstructive cardiomyopathy. Heart Rhythm 2024; 21:819-827. [PMID: 38246568 DOI: 10.1016/j.hrthm.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM) may be caused by a primary atrial myopathy. Whether HOCM-related atrial myopathy affects mainly electrophysiological properties of the left atrium (LA) or also the right atrium (RA) has never been investigated. OBJECTIVE The purpose of this study was to characterize atrial conduction and explore differences in the prevalence of conduction disorders, potential fractionation, and low-voltage areas (LVAs) between the RA and LA during sinus rhythm (SR) as indicators of potential arrhythmogenic areas. METHODS Intraoperative epicardial mapping of both atria during SR was performed in 15 HOCM patients (age 50 ± 12 years). Conduction delay (CD) and conductin block (CB), unipolar potential characteristics (voltages, fractionation), and LVA were quantified. RESULTS Conduction disorders and LVA were found scattered throughout both atria in all patients and did not differ between the RA and LA (CD: 2.9% [1.9%-3.6%] vs 2.6% [2.1%-6.4%], P = .541; CB: 1.7% [0.9%-3.1%] vs 1.5% [0.5%-2.8%], P = .600; LVA: 4.7% [1.6%-7.7%] vs 2.9% [2.1%-7.1%], P = .793). Compared to the RA, unipolar voltages of single potentials (SPs) and fractionated potentials (FPs) were higher in the LA (SP: P75 7.3 mV vs 10.9 mV; FP: P75 2.0 mV vs 3.7 mV). FP contained low-voltage components in only 18% of all LA sites compared to 36% of all RA sites. CONCLUSION In patients with HOCM, conduction disorders, LVA, and FP are equally present in both atria, supporting the hypothesis of a primary atrial myopathy. Conceptually, the presence of a biatrial substrate and high-voltage FP may contribute to failure of ablative therapy of atrial tachyarrhythmias in this population.
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Affiliation(s)
| | - Jorik H Amesz
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hoang Nguyen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter L de Jong
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Ye Z, van Schie MS, Pool L, Heida A, Knops P, Taverne YJHJ, Brundel BJJM, de Groot NMS. Characterization of unipolar electrogram morphology: a novel tool for quantifying conduction inhomogeneity. Europace 2023; 25:euad324. [PMID: 37931071 PMCID: PMC10657215 DOI: 10.1093/europace/euad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023] Open
Abstract
AIMS Areas of conduction inhomogeneity (CI) during sinus rhythm may facilitate the initiation and perpetuation of atrial fibrillation (AF). Currently, no tool is available to quantify the severity of CI. Our aim is to develop and validate a novel tool using unipolar electrograms (EGMs) only to quantify the severity of CI in the atria. METHODS AND RESULTS Epicardial mapping of the right atrium (RA) and left atrium, including Bachmann's bundle, was performed in 235 patients undergoing coronary artery bypass grafting surgery. Conduction inhomogeneity was defined as the amount of conduction block. Electrograms were classified as single, short, long double (LDP), and fractionated potentials (FPs), and the fractionation duration of non-single potentials was measured. The proportion of low-voltage areas (LVAs, <1 mV) was calculated. Increased CI was associated with decreased potential voltages and increased LVAs, LDPs, and FPs. The Electrical Fingerprint Score consisting of RA EGM features, including LVAs and LDPs, was most accurate in predicting CI severity. The RA Electrical Fingerprint Score demonstrated the highest correlation with the amount of CI in both atria (r = 0.70, P < 0.001). CONCLUSION The Electrical Fingerprint Score is a novel tool to quantify the severity of CI using only unipolar EGM characteristics recorded. This tool can be used to stage the degree of conduction abnormalities without constructing spatial activation patterns, potentially enabling early identification of patients at high risk of post-operative AF or selection of the appropriate ablation approach in addition to pulmonary vein isolation at the electrophysiology laboratory.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Lisa Pool
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
- Department of Microelectronics, Delft University of Technology, Mekelweg 5, 2628CD Delft, The Netherlands
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Centurión OA. Electrocardiographic left atrial abnormality and incident atrial fibrillation in the MESA cohort: Looking forward to easier arrhythmia prediction. Int J Cardiol 2023; 388:131092. [PMID: 37245541 DOI: 10.1016/j.ijcard.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Osmar Antonio Centurión
- Division of Cardiovascular Medicine, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay.
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Zein ELAbdeen SG, El-Dosouky II, M ELShabrawy A, Mohammed El Maghawry L. Atrial electromechanical delay in post-COVID-19 postural orthostatic tachycardia: Innocent bystander or pathologic factor. Indian Heart J 2023; 75:292-297. [PMID: 37321349 PMCID: PMC10263230 DOI: 10.1016/j.ihj.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/04/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndrome represents a wide range of ongoing symptoms that persist beyond weeks or even months, after recovery from the acute phase. Postural orthostatic tachycardia (POT) is one of these symptoms with a poorly recognized underlying pathophysiology. PURPOSE We aimed to investigate atrial electromechanical delay (AEMD), demonstrated by electrocardiographic P wave dispersion (PWD) and tissue Doppler echocardiography (TDE) in patients with POST-COVID-19 POT (PCPOT). METHODS 94 post-COVID-19 patients were enrolled and classified into two groups; PCPOT group, 34 (36.1%) patients, and normal heart rate (NR group), 60 (63.9%) patients. 31.9% of them were males and 68.1% were females, with a mean age of 35 ± 9 years. Both groups were compared in terms of PWD and AEMD. RESULTS As compared to the NR group, the PCPOT group showed a significant increase in PWD (49 ± 6 versus 25.6 ± 7.8, p < 0.001), higher CRP (37 ± 9 versus 30 ± 6, p = 0.04), prolonged left-atrial EMD, right-atrial EMD and inter-atrial EMD at (p = 0.006, 0.001, 0.002 respectively). Multivariate logistic regression analysis revealed that P wave dispersion (β 0.505, CI (0.224-1.138), p = 0.023), PA lateral (β 0.357, CI (0.214-0.697), p = 0.005), PA septal (β 0.651, CI. (0.325-0.861), p = 0.021), and intra-left atrial EMD (β 0.535, CI (0.353-1.346) p < 0.012) were independent predictors of PCPOT. CONCLUSION Atrial heterogenicity in the form of prolonged AEMD and PWD seems to be a reasonable underlying pathophysiology of PCPOT. This could provide a new concern during the management and novel pharmacological approaches in these patients.
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Ramos KS, Li J, Wijdeveld LFJ, van Schie MS, Taverne YJHJ, Boon RA, de Groot NMS, Brundel BJJM. Long Noncoding RNA UCA1 Correlates With Electropathology in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2023:S2405-500X(23)00116-0. [PMID: 37227342 DOI: 10.1016/j.jacep.2023.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Perpetuation of atrial fibrillation (AF) is rooted in derailment of molecular proteostasis pathways that cause electrical conduction disorders that drive AF. Emerging evidence indicates a role for long noncoding RNAs (lncRNAs) in the pathophysiology of cardiac diseases, including AF. OBJECTIVES In the present study, the authors explored the association between 3 cardiac lncRNAs and the degree of electropathology. METHODS Patients had paroxysmal AF (ParAF) (n = 59), persistent AF (PerAF) (n = 56), or normal sinus rhythm without a history of AF (SR) (n = 70). The relative expression levels of urothelial carcinoma-associated 1 (UCA1), OXCT1-AS1 (SARRAH), and the mitochondrial lncRNA uc022bqs.q (LIPCAR) were measured by means of quantitative reverse-transcription polymerase chain reaction in the right atrial appendage (RAA) or serum (or both). A selection of the patients was subjected to high-resolution epicardial mapping to evaluate electrophysiologic features during SR. RESULTS The expression levels of SARRAH and LIPCAR were decreased in RAAs of all AF patients compared with SR. Also, in RAAs, UCA1 levels significantly correlated with the percentage of conduction block and delay, and inversely with conduction velocity, indicating that UCA1 levels in RAA reflect the degree of electrophysiologic disorders. Moreover, in serum samples, SARRAH and UCA1 levels were increased in the total AF group and ParAF patients compared with SR. CONCLUSIONS LncRNAs SARRAH and LIPCAR are reduced in RAA of AF patients, and UCA1 levels correlate with electrophysiologic conduction abnormalities. Thus, RAA UCA1 levels may aid staging of electropathology severity and act as a patient-tailored bioelectrical fingerprint.
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Affiliation(s)
- Kennedy S Ramos
- Department of Physiology, Amsterdam Cardiovascular Sciences, Heart Failure, and Arrhythmias, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jin Li
- Department of Physiology, Amsterdam Cardiovascular Sciences, Heart Failure, and Arrhythmias, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leonoor F J Wijdeveld
- Department of Physiology, Amsterdam Cardiovascular Sciences, Heart Failure, and Arrhythmias, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Reinier A Boon
- Department of Physiology, Amsterdam Cardiovascular Sciences, Heart Failure, and Arrhythmias, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Bianca J J M Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Heart Failure, and Arrhythmias, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Ramdat Misier NL, van Schie MS, Li C, Oei FBS, van Schaagen FRN, Knops P, Taverne YJHJ, de Groot NMS. Epicardial high-resolution mapping of advanced interatrial block: Relating ECG, conduction abnormalities and excitation patterns. Front Cardiovasc Med 2023; 9:1031365. [PMID: 36712256 PMCID: PMC9878276 DOI: 10.3389/fcvm.2022.1031365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Background Impairment of conduction across Bachmann's Bundle (BB) may cause advanced interatrial block (a-IAB), which in turn is associated with development of atrial fibrillation. However, the exact relation between a complete transverse line of conduction block (CB) across BB and the presence of a-IAB has not been studied. Objective The aims of this study are to determine whether (1) a complete transversal line of CB across BB established by high resolution mapping correlates with a-IAB on the surface ECG, (2) conduction abnormalities at the right and left atria correlate with a-IAB, and (3) excitation patterns are associated with ECG characteristics of a-IAB. Methods We included 40 patients in whom epicardial mapping revealed a complete transverse line of CB across BB. Pre-operative ECGs and post-operative telemetry were assessed for the presence of (a) typical a-IAB and de novo early post-operative AF (EPOAF), respectively. Total atrial excitation time (TAET) and RA-LA delay were calculated. Entry site and trajectory of the main sinus rhythm wavefront at the pulmonary vein area (PVA) were assessed. Results Thirteen patients were classified as a-IAB (32.5%). In the entire atria and BB there were no differences in conduction disorders, though, patients with a-IAB had an increased TAET and longer RA-LA delay compared to patients without a-IAB (90.0 ± 21.9 ms vs. 74.9 ± 13.0 ms, p = 0.017; 160.0 ± 27.0 ms vs. 136.0 ± 24.1 ms, p = 0.012, respectively). Patients with typical a-IAB solely had caudocranial activation of the PVA, without additional cranial entry sites. Prevalence of de novo EPOAF was 69.2% and was similar between patients with and without a-IAB. Conclusion A transverse line of CB across BB partly explains the ECG characteristics of a-IAB. We found atrial excitation patterns underlying the ECG characteristics of both atypical and typical a-IAB. Regardless of the presence of a-IAB, the clinical impact of a complete transverse line of CB across BB was reflected by a high incidence of de novo EPOAF.
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Affiliation(s)
| | | | - Chunsheng Li
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Frans B. S. Oei
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
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van Schie MS, de Groot NMS. Clinical Relevance of Sinus Rhythm Mapping to Quantify Electropathology Related to Atrial Fibrillation. Arrhythm Electrophysiol Rev 2022; 11:e11. [PMID: 35846426 PMCID: PMC9277615 DOI: 10.15420/aer.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022] Open
Abstract
Progression of AF is accompanied by structural and electrical remodelling, resulting in complex electrical conduction disorders. This is defined as electropathology and it increases with the progression of AF. The severity of electropathology, thus, defines the stage of AF and is a major determinant of effectiveness of AF therapy. As specific features of AF-related electropathology are still unknown, it is essential to first quantify the electrophysiological properties of atrial tissue and then to examine the inter- and intra-individual variation during normal sinus rhythm. Comparison of these parameters between patients with and without a history of AF unravels quantified electrophysiological features that are specific to AF patients. This can help to identify patients at risk for early onset or progression of AF. This review summarises current knowledge on quantified features of atrial electrophysiological properties during sinus rhythm and discusses its relevance in identifying AF-related electropathology.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja MS de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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8
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S. Ramos K, Pool L, van Schie MS, Wijdeveld LFJM, van der Does WFB, Baks L, Sultan HMD, van Wijk SW, Bogers AJJC, Verheule S, de Groot NMS, Brundel BJJM. Degree of Fibrosis in Human Atrial Tissue Is Not the Hallmark Driving AF. Cells 2022; 11:cells11030427. [PMID: 35159236 PMCID: PMC8834228 DOI: 10.3390/cells11030427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The current paradigm is that fibrosis promotes electrophysiological disorders and drives atrial fibrillation (AF). In this current study, we investigated the relation between the degree of fibrosis in human atrial tissue samples of controls and patients in various stages of AF and the degree of electrophysiological abnormalities. Methods: The degree of fibrosis was measured in the atrial tissue and serum of patients in various stages of AF and the controls. Hereto, picrosirius and H&E staining were performed to quantify degree of total, endo-perimysial fibrosis, and cardiomyocyte diameter. Western blot quantified fibrosis markers: neural cell adhesion molecule, tissue inhibitor of metalloproteinase, lysyl oxidase, and α-smooth muscle actin. In serum, the ratio carboxyl-terminal telopeptide of collagen/matrix-metalloproteinase1 was determined. High-resolution epicardial mapping evaluated low-voltage areas and conduction abnormalities. Results: No significant differences were observed in the degree of fibrosis between the groups. Finally, no significant correlation—absolute nor spatial—was observed between all electrophysiological parameters and histological fibrosis markers. Conclusions: No differences in the degree of fibrosis were observed in patients from various stages of AF compared to the controls. Moreover, electrophysiological abnormalities did not correlate with any of the fibrosis markers. The findings indicate that fibrosis is not the hallmark of structural remodeling in AF.
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Affiliation(s)
- Kennedy S. Ramos
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
- Department Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.v.S.); (W.F.B.v.d.D.); (N.M.S.d.G.)
- Correspondence: (K.S.R.); (B.J.J.M.B.)
| | - Lisa Pool
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
- Department Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.v.S.); (W.F.B.v.d.D.); (N.M.S.d.G.)
| | - Mathijs S. van Schie
- Department Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.v.S.); (W.F.B.v.d.D.); (N.M.S.d.G.)
| | - Leonoor F. J. M. Wijdeveld
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
| | - Willemijn F. B. van der Does
- Department Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.v.S.); (W.F.B.v.d.D.); (N.M.S.d.G.)
| | - Luciënne Baks
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
| | - H. M. Danish Sultan
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
| | - Stan W. van Wijk
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Sander Verheule
- Department of Physiology, University Maastricht, 6211 LK Maastricht, The Netherlands;
| | - Natasja M. S. de Groot
- Department Cardiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.v.S.); (W.F.B.v.d.D.); (N.M.S.d.G.)
| | - Bianca J. J. M. Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands; (L.P.); (L.F.J.M.W.); (L.B.); (H.M.D.S.); (S.W.v.W.)
- Correspondence: (K.S.R.); (B.J.J.M.B.)
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Low Voltage Potentials Contribute to Post-Operative Atrial Fibrillation Development in Obese Patients. Heart Rhythm 2022; 19:710-718. [DOI: 10.1016/j.hrthm.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
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AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle. J Clin Med 2021; 10:jcm10235536. [PMID: 34884237 PMCID: PMC8658171 DOI: 10.3390/jcm10235536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
We investigated whether patterns of activation at Bachmann’s bundle are related to AF inducibility. Epicardial mapping of Bachmann’s bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2–164) mm vs. 6(2–28) mm, p = 0.048), prolonged total activation time (55(28–143) ms vs. 46(24–73) ms, p = 0.012), multiple wavefronts entering Bachmann’s bundle more frequently (64% vs. 37%, p = 0.046) and more often areas of simultaneous activation (conduction velocity > 1.7 m/s, 45% vs. 16%, p = 0.038). These observations further support a relation between conduction abnormalities at Bachmann’s bundle and AF inducibility. The next step is to examine whether Bachmann’s bundle activation patterns can also be used to identify patients who will develop AF after cardiac surgery during both short- and long-term follow-up.
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Heida A, van der Does WFB, van Staveren LN, Taverne YJHJ, Roos-Serote MC, Bogers AJJC, de Groot NMS. Conduction Heterogeneity: Impact of Underlying Heart Disease and Atrial Fibrillation. JACC Clin Electrophysiol 2021; 6:1844-1854. [PMID: 33357582 DOI: 10.1016/j.jacep.2020.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study is to investigate the impact of various underlying heart diseases (UHDs) and prior atrial fibrillation (AF) episodes on conduction heterogeneity. BACKGROUND It is unknown whether intra-atrial conduction during sinus rhythm differs between various UHD or is influenced by AF episodes. METHODS Epicardial sinus rhythm mapping of the right atrium, Bachmann's bundle (BB), left atrium and pulmonary vein area was performed in 447 participants (median age: 67 [interquartile range (IQR): 59 to 73] years) with or without AF undergoing cardiac surgery for ischemic heart disease, (ischemic and) valvular heart disease, or congenital heart disease. Conduction times (CTs) were defined as Δ local activation time between 2 adjacent electrodes and used to assess frequency (CTs ≥ 4 ms) and magnitude of conduction disorders (in increments of 10 ms). RESULTS When comparing the 3 types of UHD, there were no differences in frequencies and magnitude of CTs at all locations (p ≥ 0.017 and p ≥ 0.005, respectively). Prior AF episodes were associated with conduction slowing throughout both atria (14.9% [IQR: 11.8 to 17.0] vs. 12.8% [IQR: 10.9 to 14.6]; p < 0.001). At BB, CTs with magnitudes ≥30 ms were more common in patients with AF (n = 56.2% vs. n = 36.0%; p < 0.004). CONCLUSIONS UHD has no impact on the frequency and severity of conduction disorders. AF episodes are associated with more conduction disorders throughout both atria and with more severe conduction disorders at BB. The next step will be to determine the relevance of these conduction disorders for AF development and maintenance.
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Affiliation(s)
- Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Conduction Disorders during Sinus Rhythm in Relation to Atrial Fibrillation Persistence. J Clin Med 2021; 10:jcm10132846. [PMID: 34199081 PMCID: PMC8269325 DOI: 10.3390/jcm10132846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/25/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Classification of atrial fibrillation (AF) is currently based on clinical characteristics. However, classifying AF using an objective electrophysiological parameter would be more desirable. The aim of this study was to quantify parameters of atrial conduction during sinus rhythm (SR) using an intra-operative high-resolution epicardial mapping approach and to relate these parameters to clinical classifications of AF. Patients were divided according to the standard clinical classification and spontaneous termination of AF episodes. The HATCH score, a score predictive of AF progression, was calculated, and surface ECGs were evaluated for signs of interatrial block. Conduction disorders mainly differed at Bachmann’s bundle (BB). Activation time (AT) at BB was longer in persistent AF patients (AT-BB: 75 (53–92) ms vs. 55 (40–76) ms, p = 0.017), patients without spontaneous termination of AF episodes (AT-BB: 53.5 (39.6–75.8) ms vs. 72.0 (49.6–80.8) ms, p = 0.009) and in patients with a P-wave duration ≥ 120 ms (64.3 (52.3–93.0) ms vs. 50.5 (39.6–56.6) ms, p = 0.014). HATCH scores also correlated positively to AT-BB (rho 0.326, p = 0.029). However, discriminatory values of electrophysiological parameters, as calculated using ROC-curves, were limited. These results may reflect shortcomings of clinical classifications and further research is needed to establish an objective substrate-based classification of AF.
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13
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Khan MS, Lange M, Ranjan R, Sharma V, Glotzbach JP, Selzman C, Dosdall DJ. Premature atrial stimulation accentuates conduction abnormalities in cardiac surgery patients that develop postoperative atrial fibrillation. J Electrocardiol 2021; 69:36-43. [PMID: 34555557 PMCID: PMC9265137 DOI: 10.1016/j.jelectrocard.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND postoperative atrial fibrillation (POAF) is a common cardiac surgery complication that is associated with increased complications and negative outcomes, but the association between presurgical atrial conduction abnormalities and POAF has not been investigated clinically during premature atrial S1S2 stimulation. This clinical study sought to examine whether intraoperative premature atrial stimulation reveals increased areas of slowed and/or blocked conduction in patients that develop POAF. METHODS High-density intraoperative epicardial left atrial mapping was conducted in 20 cardiac surgery patients with no prior history of atrial fibrillation (AF). In 20 patients, 6 (30%) developed POAF. A flexible-array of 240-electrodes was placed on the posterior left atrial wall in between the pulmonary veins. Activation maps were generated for sinus and premature atrial S1S2 stimulated beats. The area of conduction block (CB), conduction delay (CD) and the combination of both (CDCB) for conduction velocity < 0.1, 0.1 ≤ x < 0.2 and < 0.2 m/s, respectively were quantified. RESULTS For a premature atrial S2 beat with shortest cycle length captured, conduction velocity maps revealed a significantly higher area for CD (13.19 ± 6.59 versus 6.06 ± 4.22 mm2, p = 0.028) and CDCB (17.36 ± 8.75 versus 7.41 ± 6.39 mm2, p = 0.034), and a trend toward a larger area for CB (4.17 ± 3.66 versus 1.34 ± 2.86 mm2, p = 0.063) in patients who developed POAF in comparison to those that remained in the sinus. Sinus and S1 paced beats did not show substantial differences in abnormal conduction areas between patients with and without POAF. CONCLUSION In comparison to sinus and S1 beats, premature atrial S2 beats accentuate conduction abnormalities in the posterior left atrial wall of cardiac surgery patients that developed POAF.
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Affiliation(s)
- Muhammad S. Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Matthias Lange
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Department of Bioengineering, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Jason P. Glotzbach
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Craig Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA
| | - Derek J. Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Department of Bioengineering, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Division of Cardiothoracic Surgery, Department of Surgery, The University of Utah – Health, Salt Lake City, UT 84112, USA.,Address For Correspondence: Dr. Derek J. Dosdall, PhD, FHRS, FAHA, Associate Professor of Surgery, Division of Cardiothoracic Surgery, The University of Utah – Health, Salt Lake City, UT 84112 USA, / Ph: (+1) 801-587-2036
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14
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Kharbanda RK, Knops P, van der Does LJME, Kik C, Taverne YJHJ, Roos‐Serote MC, Heida A, Oei FBS, Bogers AJJC, de Groot NMS. Simultaneous Endo-Epicardial Mapping of the Human Right Atrium: Unraveling Atrial Excitation. J Am Heart Assoc 2020; 9:e017069. [PMID: 32808551 PMCID: PMC7660792 DOI: 10.1161/jaha.120.017069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022]
Abstract
Background The significance of endo-epicardial asynchrony (EEA) and atrial conduction block (CB), which play an important role in the pathophysiology of atrial fibrillation (AF) during sinus rhythm is poorly understood. The aim of our study was therefore to examine 3-dimensional activation of the human right atrium (RA). Methods and Results Eighty patients (79% men, 39% history of AF) underwent simultaneous endo-epicardial sinus rhythm mapping of the inferior, middle and superior RA. Areas of CB were defined as conduction delays of ≥12 ms, EEA as activation time differences of opposite electrodes of ≥15 ms and transmural CB as CB at similar endo-epicardial sites. CB was more pronounced at the endocardium (all locations P<0.025). Amount, extensiveness and severity of CB was higher at the superior RA. Transmural CB at the inferior RA was associated with a higher incidence of post-operative AF (P=0.03). EEA occurred up to 84 ms and was more pronounced at the superior RA (superior: 27 ms [interquartile range, 18.3-39.3], versus mid-RA: 20.3 ms [interquartile range, 0-29.9], and inferior RA: 0 ms [interquartile range, 0-21], P<0.001). Hypertension (P=0.009), diabetes mellitus (P=0.018), and hypercholesterolemia (P=0.015) were associated with a higher degree of EEA. CB (P=0.007) and EEA (P=0.037) were more pronounced in patients with a history of persistent AF compared with patients without AF history. Conclusions This study provides important insights into complex atrial endo-epicardial excitation. Significant differences in conduction disorders between the endo- and epicardium and a significant degree of EEA are already present during sinus rhythm and are more pronounced in patients with cardiovascular risk factors or a history of persistent AF.
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Affiliation(s)
- Rohit K. Kharbanda
- Department of CardiologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Cardiothoracic SurgeryErasmus Medical CenterRotterdamThe Netherlands
| | - Paul Knops
- Department of CardiologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Charles Kik
- Department of Cardiothoracic SurgeryErasmus Medical CenterRotterdamThe Netherlands
| | | | | | - Annejet Heida
- Department of CardiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Frans B. S. Oei
- Department of Cardiothoracic SurgeryErasmus Medical CenterRotterdamThe Netherlands
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic SurgeryErasmus Medical CenterRotterdamThe Netherlands
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15
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R Schill M, S Cuculich P, M Andrews C, Vijayakumar R, Ruaengsri C, C Henn M, S Lancaster T, J Melby S, B Schuessler R, Rudy Y, J Damiano R. The Arrhythmic Substrate for Atrial Fibrillation in Patients with Mitral Regurgitation. J Atr Fibrillation 2020; 13:2304. [PMID: 34950292 DOI: 10.4022/jafib.2304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022]
Abstract
Objective Patients with severe mitral regurgitation commonly develop atrial fibrillation. The precise mechanisms of this relationship remain unknown. The objective of this study was to apply noninvasive electrocardiographic imaging of the atria during sinus rhythm to identify changes in atrial electrophysiology that may contribute to development of atrial fibrillation in patients with severe mitral regurgitation referred for mitral valve surgery. Methods Twenty subjects (9 atrial fibrillation and mitral regurgitation, 11 mitral regurgitation alone) underwent electrocardiographic imaging. Biatrial electrophysiology was imaged with activation maps in sinus rhythm. The reconstructed unipolar electrograms were analyzed for voltage amplitude, number of deflections and conduction heterogeneity. In subjects with mitral regurgitation, left atrial biopsies were obtained at the time of surgery. Results: Subjects with history of atrial fibrillation demonstrated prolonged left atrial conduction times (110±25 ms vs. mitral regurgitation alone (85±21), p=0.025); right atrial conduction times were unaffected. Variable patterns of conduction slowing were imaged in the left atria of most subjects, but those with prior history of atrial fibrillation had more complex patterns of conduction slowing or unidirectional block. The presence of atrial fibrillation was not associated with the extent of fibrosis in atrial biopsies. Conclusions Detailed changes in sinus rhythm atrial electrophysiology can be imaged noninvasively and can be used to assess the impact and evolution of atrial fibrillation on atrial conduction properties in patients with mitral regurgitation. If replicated in larger studies, electrocardiographic imaging may identify patients with mitral regurgitation at risk for atrial fibrillation and could be used to guide treatment strategies.
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Affiliation(s)
- Matthew R Schill
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA
| | - Christopher M Andrews
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ramya Vijayakumar
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Chawannuch Ruaengsri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Matthew C Henn
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Timothy S Lancaster
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Spencer J Melby
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Richard B Schuessler
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Yoram Rudy
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ralph J Damiano
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
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16
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Teuwen CP, van der Does LJ, Kik C, Mouws EM, Lanters EA, Knops P, Taverne YJ, Bogers AJ, de Groot NM. Sinus Rhythm Conduction Properties across Bachmann's Bundle: Impact of Underlying Heart Disease and Atrial Fibrillation. J Clin Med 2020; 9:jcm9061875. [PMID: 32560096 PMCID: PMC7355925 DOI: 10.3390/jcm9061875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Valvular heart disease (VHD) is a common risk factor for atrial fibrillation (AF). Conduction abnormalities (CA) during sinus rhythm (SR) across Bachmann’s bundle (BB) are associated with AF development. The study goal is to compare electrophysiological characteristics across BB during SR between patients with ischemic (IHD) and/or VHD either with or without ischemic heart disease ((I)VHD), with/without AF history using high-resolution intraoperative epicardial mapping. In total, 304 patients (IHD: n = 193, (I)VHD: n = 111) were mapped; 40 patients (13%) had a history of AF. In 116 patients (38%) there was a mid-entry site with a trend towards more mid-entry sites in patients with (I)VHD vs. IHD (p = 0.061), whereas patients with AF had significant more mid-entry sites than without AF (p = 0.007). CA were present in 251 (95%) patients without AF compared to 39 (98%) with AF. The amount of CA was comparable in patients with IHD and (I)VHD (p > 0.05); AF history was positively associated with the amount of CA (p < 0.05). Receiver operating characteristic (ROC) curve showed 85.0% sensitivity and 86.4% specificity for cut-off values of CA lines of respectively ≤ 6 mm and ≥ 26 mm. Patients without a mid-entry site or long CA lines (≥ 12 mm) were unlikely to have AF (sensitivity 90%, p = 0.002). There are no significant differences in entry-sites of wavefronts and long lines of CA between patients with IHD compared to (I)VHD. However, patients with AF have more wavefronts entering in the middle of BB and a higher incidence of long CA lines compared to patients without a history of AF. Moreover, in case of absence of a mid-entry site or long line of CA, patients most likely have no history of AF.
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Affiliation(s)
- Christophe P. Teuwen
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Lisette J.M.E. van der Does
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Charles Kik
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Elisabeth M.J.P. Mouws
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Eva A.H. Lanters
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Paul Knops
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Yannick J.H.J. Taverne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Ad J.J.C. Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Natasja M.S. de Groot
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
- Correspondence: ; Tel.: +31-10-703-5018; Fax: +31-10-703-5258
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17
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Schram-Serban C, Heida A, Roos-Serote MC, Knops P, Kik C, Brundel B, Bogers AJJC, de Groot NMS. Heterogeneity in Conduction Underlies Obesity-Related Atrial Fibrillation Vulnerability. Circ Arrhythm Electrophysiol 2020; 13:e008161. [PMID: 32301327 DOI: 10.1161/circep.119.008161] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obese patients are more vulnerable to development of atrial fibrillation but pathophysiology underlying this relation is only partly understood. The aim of this study is to compare the severity and extensiveness of conduction disorders between obese patients and nonobese patients measured at a high-resolution scale. METHODS Patients (N=212) undergoing cardiac surgery (male:161, 63±11 years) underwent epicardial mapping of the right atrium, Bachmann bundle, and left atrium during sinus rhythm. Conduction delay (CD) was defined as interelectrode conduction time of 7 to 11 ms and conduction block (CB) as conduction time ≥12 ms. Prevalence of CD/CB, continuous CDCB (cCDCB), length of CD/CB/cCDCB lines, and severity of CB were analyzed. RESULTS In obese patients, the overall incidence of CD (3.1% versus 2.6%; P=0.002), CB (1.8% versus 1.2%; P<0.001), and cCDCB (2.6% versus 1.9%; P<0.001) was higher and CD (P=0.012) and cCDCB (P<0.001) lines are longer. There were more conduction disorders at Bachmann bundle and this area has a higher incidence of CD (4.4% versus 3.3%, P=0.002), CB (3.1% versus 1.6%, P<0.001), cCDCB (4.6% versus 2.7%, P<0.001) and longer CD (P<0.001) or cCDCB (P=0.017) lines. The severity of CB is also higher, particularly in the Bachmann bundle (P=0.008) and pulmonary vein (P=0.020) areas. In addition, obese patients have a higher incidence of early de-novo postoperative atrial fibrillation (P=0.003). Body mass index (P=0.037) and the overall amount of CB (P=0.012) were independent predictors for incidence of early postoperative atrial fibrillation. CONCLUSIONS Compared with nonobese patients, obese patients have higher incidences of conduction disorders, which are also more extensive and more severe. These differences in heterogeneity in conduction are already present during sinus rhythm and may explain the higher vulnerability to atrial fibrillation of obese patients.
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Affiliation(s)
- Corina Schram-Serban
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Annejet Heida
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Maarten C Roos-Serote
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Paul Knops
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Charles Kik
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Bianca Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam (B.B.).,Cardiovascular Sciences, Amsterdam, The Netherlands (B.B.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Natasja M S de Groot
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
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18
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Houck CA, Lanters EAH, Heida A, Taverne YJHJ, van de Woestijne PC, Knops P, Roos-Serote MC, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Distribution of Conduction Disorders in Patients With Congenital Heart Disease and Right Atrial Volume Overload. JACC Clin Electrophysiol 2020; 6:537-548. [PMID: 32439038 DOI: 10.1016/j.jacep.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study sought to quantify characteristics of atrial conduction disorders in patients with right atrial (RA) volume overload. BACKGROUND Patients with an interatrial shunt are prone to developing atrial fibrillation (AF), which may be related to conduction disorders occurring due to atrial stretch. METHODS Thirty-one patients undergoing surgery for an interatrial shunt (49 ± 14 years of age) underwent epicardial sinus rhythm mapping of the RA, Bachmann's bundle (BB), and left atrium (LA). Conduction delay (CD) was defined as interelectrode conduction time (CT) of 7 to 11 ms and conduction block (CB) as CT ≥12 ms. Prevalence of CD or CB (percentage of mapped region), length of lines, and severity of CB (75th percentile of CTs ≥12 ms) were analyzed. RESULTS All patients had some degree of CD and CB. Prevalence of CD and CB was higher in the RA and BB than in the LA (p < 0.0083 after Bonferroni correction). The longest CB line within each patient was found in the RA in most patients (52%). Interindividual variation in prevalence and lengths of lines was considerable. CB was more severe in the RA than in the LA (p < 0.0083). Within the RA, conduction disorders were more prevalent and more severe in the intercaval region than in the RA free wall (p < 0.05). CONCLUSIONS In patients with an interatrial shunt, conduction disorders during sinus rhythm are most pronounced in the RA-particularly the intercaval region-and BB. Knowledge of the conduction during sinus rhythm is essential to determine the relevance of conduction disorders for initiation and perpetuation of AF.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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19
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Knops P, Schram-Serban C, van der Does L, Croes M, Houben R, de Groot N. Impact of atrial programmed electrical stimulation techniques on unipolar electrogram morphology. J Cardiovasc Electrophysiol 2020; 31:943-951. [PMID: 32057165 DOI: 10.1111/jce.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intra-atrial conduction abnormalities are associated with the development of atrial fibrillation (AF) and cause morphological changes of the unipolar atrial electrogram (U-AEGM). This study examined the impact of different atrial programmed electrical stimulation (APES) protocols on U-AEGM morphology to identify the most optimal APES protocol provoking conduction abnormalities. METHODS APES techniques (14 protocols) were applied in 30 patients referred for an electrophysiology study, consisting of fixed rate, extra, and decremental stimuli at different frequencies. U-AEGM morphologies including width, amplitude, and fractionation for patients without (control group) and with a history of AF (AF group) were examined during APES. In addition, sinus rhythm (SR) U-AEGMs preceding different APES protocols were compared to evaluate the morphology stability over time. RESULTS U-AEGM morphologies during SR before the APES protocols were comparable (all P > .396). Atrial refractoriness was longer in the AF group compared to the control group (298 ± 48 vs 255 ± 33 ms; P ≤ .020), but did not differ between AF patients with and without amiodarone therapy (278 ± 48 vs 311 ± 40 ms; P ≥ .126). Compared to the initial SR morphology, U-AEGM width, amplitude, and fractionation changed significantly during the 14 different APES protocols, particularly in the AF group. In both groups, U-AEGM changes in morphology were most pronounced during fixed-rate stimulation with extra stimuli (8S1-S2 = 400-250 ms). CONCLUSION APES results in significant changes in U-AEGM morphology, including width, amplitude, and fractionation. The impact of APES differed between APES sequence and between patients with and without AF. These findings suggest that APES could be useful to identify AF-related conduction abnormalities in the individual patient.
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Affiliation(s)
- Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Marshall Croes
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Natasja de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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20
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van der Does LJME, Lanters EAH, Teuwen CP, Mouws EMJP, Yaksh A, Knops P, Kik C, Bogers AJJC, de Groot NMS. The Effects of Valvular Heart Disease on Atrial Conduction During Sinus Rhythm. J Cardiovasc Transl Res 2019; 13:632-639. [PMID: 31773460 PMCID: PMC7423861 DOI: 10.1007/s12265-019-09936-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
Abstract
Different arrhythmogenic substrates for atrial fibrillation (AF) may underlie aortic valve (AV) and mitral valve (MV) disease. We located conduction disorders during sinus rhythm by high-resolution epicardial mapping in patients undergoing AV (n = 85) or MV (n = 54) surgery. Extent and distribution of conduction delay (CD) and block (CD) across the entire right and left atrial surface was determined from circa 1880 unipolar electrogram recordings per patient. CD and CB were most pronounced at the superior intercaval area (2.5% of surface, maximal degree 6.6%/cm2). MV patients had a higher maximal degree of CD at the lateral left atrium than AV patients (4.2 vs 2.3%/cm2, p = 0.001). A history of AF was most strongly correlated to CD/CB at Bachmann’s bundle and age. Although MV patients have more conduction disorders at the lateral left atrium, disturbed conduction at Bachmann’s bundle during sinus rhythm indicates the presence of atrial remodeling which is related to AF episodes.
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Affiliation(s)
- Lisette J M E van der Does
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Elisabeth M J P Mouws
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ameeta Yaksh
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Markowitz SM, Choi DY, Daian F, Liu CF, Cheung JW, Thomas G, Ip JE, Lerman BB. Regional isolation in the right atrium with disruption of intra-atrial conduction after catheter ablation of atrial tachycardia. J Cardiovasc Electrophysiol 2019; 30:1773-1785. [PMID: 31225670 DOI: 10.1111/jce.14037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ablation of atrial tachycardia (AT) that occurs after cardiac surgery or prior ablation often requires complex lesion sets. In combination with the pre-existing atrial scar, these lesion sets may result in inadvertent intra-atrial conduction block. This study reports the phenomenon of incidental isolation of right atrial (RA) regions that occurs secondary to AT ablation, which in some cases results in profound bradycardia due to sinus exit block. METHODS AND RESULTS Intracardiac electrograms were examined in consecutive patients who underwent AT ablation in the RA. Cases of localized isolation of the RA were defined as areas that developed electrical dissociation during ablation. Of 132 patients having ablation in both the RA free wall and the cavotricuspid isthmus (CTI), 10 (7.6%) developed unintentional isolation of the lateral RA. Five of these patients had prior mitral valve surgery, comprising 12.2% of all 41 patients with mitral surgery who underwent ablation in the CTI and the RA free wall. All patients with regional isolation had a pre-existing scar in the lateral wall of the RA. In six patients, isolation of the lateral RA resulted in profound bradycardia due to exit block from the peri-sinus node myocardium. CONCLUSIONS Complex ablation lesions in patients with prior valve surgery, prior ablation, or atrial myopathy may result in unintended localized conduction block in the RA. In some cases, isolation of the lateral RA can result in complete sinus exit block with profound bradycardia requiring pacemaker implantation.
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Affiliation(s)
- Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Daniel Y Choi
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Foysal Daian
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, New York
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22
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Mouws EM, van der Does LJ, Kik C, Lanters EA, Teuwen CP, Knops P, Bogers AJ, de Groot NM. Impact of the arrhythmogenic potential of long lines of conduction slowing at the pulmonary vein area. Heart Rhythm 2019; 16:511-519. [DOI: 10.1016/j.hrthm.2018.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Indexed: 10/28/2022]
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23
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Abdi B, Hendriks RC, van der Veen AJ, de Groot NM. A compact matrix model for atrial electrograms for tissue conductivity estimation. Comput Biol Med 2019; 107:284-291. [DOI: 10.1016/j.compbiomed.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
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24
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Lanters EAH, Teuwen CP, Yaksh A, Kik C, van der Does LJME, Mouws EMJP, Knops P, van Groningen NJ, Hokken T, Bogers AJJC, de Groot NMS. Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation. J Am Heart Assoc 2018. [PMID: 29525787 PMCID: PMC5907553 DOI: 10.1161/jaha.117.007879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early postoperative atrial fibrillation (EPoAF) is associated with thromboembolic events, prolonged hospitalization, and development of late PoAF (LPoAF). It is, however, unknown if EPoAF can be predicted by intraoperative AF inducibility. The aims of this study are therefore to explore (1) the value of intraoperative inducibility of AF for development of both EPoAF and LPoAF and (2) the predictive value of de novo EPoAF for recurrence of LPoAF. Methods and Results Patients (N=496, 75% male) undergoing cardiothoracic surgery for coronary and/or valvular heart disease were included. AF induction was attempted by atrial pacing, before extracorporeal circulation. All patients were on continuous rhythm monitoring until discharge to detect EPoAF. During a follow‐up period of 2 years, LPoAF was detected by ECGs and Holter recordings. Sustained AF was inducible in 56% of patients. There was no difference in patients with or without AF before surgery (P=0.159), or between different types of surgery (P=0.687). In patients without a history of AF, incidence of EPoAF and LPoAF was 37% and 2%, respectively. EPoAF recurred in 58% patients with preoperative AF, 53% developed LPoAF. There were no correlations between intraoperative inducibility and EPoAF or LPoAF (P>0.05). EPoAF was not correlated with LPoAF in patients without a history of AF (P=0.116), in contrast to patients with AF before surgery (P<0.001). Conclusions Intraoperative AF inducibility does not predict development of either EPoAF or LPoAF. In patients with AF before surgery, EPoAF is correlated with LPoAF recurrences. This correlation is absent in patients without AF before surgery.
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Affiliation(s)
- Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ameeta Yaksh
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Elisabeth M J P Mouws
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thijmen Hokken
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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