Effect of Atrial Fibrillation on Atrial Refractoriness in Humans

Daoud, Emile G.; Bogun, Frank; Goyal, Rajiva; Harvey, Mark; Man, K. Ching; Strickberger, S. Adam; Morady, Fred

doi:10.1161/01.cir.94.7.1600

Cited by 340 publications

(189 citation statements)

References 27 publications

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“…The study results did not, however, confirm the results of earlier studies, in animals as well as in humans [10][11][12], that patients with short duration of AF are more likely to remain in sinus rhythm after successful cardioversion. This might be explained by the fact that the duration of AF was long even in the patients with the shortest duration (e.g.…”

Section: Discussioncontrasting

confidence: 99%

“…Time from start of AF is considered critical for success of cardioversion and for maintenance of sinus rhythm [10][11][12][13]. Although warfarin sodium treatment before cardioversion is recommended for 3-4 weeks at a therapeutic international normalized ratio (INR), it is not clear, in clinical practice, how long the actual time period is from start of warfarin sodium treatment to cardioversion.…”

Section: Introductionmentioning

confidence: 99%

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Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation

Ryman

Frick

Frykman

et al. 2003

Journal of Internal Medicine

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Objectives. To evaluate the duration of anticoagulation treatment with warfarin sodium before elective DC-cardioversion and to identify clinical variables predicting short-term versus long-term waiting times. Design. Retrospective. Subjects. Patients with a known start date for warfarin sodium, a known duration of atrial fibrillation (AF) and who underwent DC-cardioversion were included. Main outcome measures. Duration of treatment with warfarin sodium prior to DC-cardioversion. Methods. The hospital records of 288 consecutive patients with AF scheduled for elective cardioversion at two hospitals in Stockholm were reviewed. Only patients with a known start date for warfarin sodium and known duration of AF were included in the study.Results. The median age was 70 (26-85) years and the duration of AF at time of cardioversion were 18 weeks (5-273) weeks. The median treatment duration prior to cardioversion with warfarin sodium was 12 weeks. Sinus rhythm was established in 224 (78%) patients of which 90 (40%) remained in sinus rhythm 1 month after cardioversion. In multivariate analysis, the only independent predictor of short waiting times for cardioversion (8 vs. 15 weeks) was if a cardiologist instituted the treatment with warfarin sodium (P < 0.001, 95% CI 5.0-9.0). Conclusion. The average waiting time from start of warfarin sodium treatment to elective cardioversion exceeds by far the recommended 3-4 weeks on therapeutic international normalized ratio (INR). In order to minimize the time period until cardioversion significant changes in the out-of-hospital care logistics has to be undertaken.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation

Ryman

Frick

Frykman

et al. 2003

Journal of Internal Medicine

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“…Nevertheless, in our study the ERP measurements at different sites where not different between groups. Previous studies have demonstrated that AF lead to a decrease in atrial ERP, without a significant change in conduction velocity [18,19]. A shorter ERP can create a shorter wavelength (ERP × conduction velocity), which significantly contributes to the maintenance of AF [20].…”

Section: Atrial Refractory Periodsmentioning

confidence: 99%

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Oliveira

Silva

Timóteo

et al. 2009

International Journal of Cardiology

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The impact of atrial dispersion of refractoriness (Disp_A) in the inducibility and maintenance of atrial fibrillation (AF) has not been fully resolved. Aim: To study the Disp_A and the vulnerability (A_Vuln) for the induction of self-limited (b 60 s) and sustained episodes of AF. Methods and results: Forty-seven patients with paroxysmal AF (PAF): 29 patients without structural heart disease and 18 with hypertensive heart disease. Atrial effective refractory period (ERP) was assessed at five sites -right atrial appendage and low lateral right atrium, high interatrial septum, proximal and distal coronary sinus. We compared three groups: group A -AF not inducible (n = 13); group B -AF inducible, self-limited (n = 18); group C -AF inducible, sustained (n = 16). Age, lone AF, hypertension, left atrial and left ventricular (LV) dimensions, LV systolic function, duration of AF history, atrial flutter/tachycardia, previous antiarrhythmics, and Disp_A were analysed with logistic regression to determine association with A_Vuln for AF inducibility. The ERP at different sites showed no differences among the groups. Group A had a lower Disp_A compared to group B (47 ± 20 ms vs 82 ± 65 ms; p = 0.002), and when compared to group C (47 ± 20 ms vs 80 ± 55 ms; p = 0.008). There was no significant difference in Disp_A between groups B and C. By means of multivariate regression analysis, the only predictor of A_Vuln was Disp_A (p = 0.04). Conclusion: In patients with PAF, increased Disp_A represents an electrophysiological marker of A_Vuln. Inducibility of both self-limited and sustained episodes of AF is associated with similar values of Disp_A. These findings suggest that the maintenance of AF is influenced by additional factors.

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“…[12][13][14] However, the mechanism of spontaneous termination of AF is still unclear. A change in vagal activity is one possible mechanism because decreased vagal tone promotes a shortened atrial refractory period and terminates AF.…”

Section: Mechanism Of Termination Of Afmentioning

confidence: 99%

Role of Fibrillation Cycle Length in Spontaneous and Drug-Induced Termination of Human Atrial Fibrillation-Spectral Analysis of Fibrillation Waves From Surface Electrocardiogram-

Fujiki

Sakabe

Nishida

et al. 2003

Circ J

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persistently rapid rate of atrial excitation produces a progressive shortening of the atrial effective refractory period and promotes the perpetuation of atrial fibrillation (AF); 1,2 however, most paroxysmal AF terminates spontaneously within a few days despite the presence of atrial remodeling. Termination of human AF with class I antiarrhythmic drugs is preceded by an increase in fibrillation cycle length (FCL), and a failure to increase the FCL correlates with a failure to terminate the AF with medication. 3 In canine models of AF, the mapping data suggest that the increase in FCL induced by antiarrhythmic drugs may relate to fusion of wavelets, an increase in the size of reentry circuits, a decrease in circuit number and finally, termination of AF. 4 Compared with drug-induced termination, the mechanism of spontaneous termination of human AF is still unclear. It is difficult to obtain intracardiac recordings just prior to spontaneous termination of paroxysmal AF for analysis of the fibrillation waves because spontaneous

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Effect of Atrial Fibrillation on Atrial Refractoriness in Humans

Cited by 340 publications

References 27 publications

Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation

Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

Role of Fibrillation Cycle Length in Spontaneous and Drug-Induced Termination of Human Atrial Fibrillation-Spectral Analysis of Fibrillation Waves From Surface Electrocardiogram-

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