Regional Differences in the Recovery Course of Tachycardia-Induced Changes of Atrial Electrophysiological Properties

Lee, Shih‐Huang; Lin, Fang‐Yue; Yu, Wen‐Chung; Cheng, Jun-Jack; Kuan, Peiliang; Hung, Chi‐Ren; Chang, Mau‐Song; Chen, Shih‐Ann

doi:10.1161/01.cir.99.9.1255

Cited by 70 publications

(50 citation statements)

References 26 publications

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“…The relative spatial distributions of atrial rate maladaptation and remodeling 4 may increase APD dispersion to facilitate the transition to and maintenance of AF. These spatially nonuniform repolarization dynamics may help to explain why repolarization sequence is less responsive to activation sequence in the atrium 9,11,24 than the ventricle. 25 Although we studied APD during Afl, the majority of prior studies have been made after electrical cardioversion from tachycardia, 8,15,17,24 meaning that those APDs were often measured at slower (nontachycardia) rates and may also have been influenced by the electrical shock.…”

Section: Nonuniformity and Rate Maladaptation Of Atrial Apdmentioning

confidence: 99%

Alternans of Atrial Action Potentials During Atrial Flutter as a Precursor to Atrial Fibrillation

et al. 2002

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Background-The mechanisms underlying the transition of typical atrial flutter (Afl) to fibrillation (AF) remain unclear.We set out to test the hypothesis that Afl disorganizes to AF via alternans of atrial action potentials. Methods and Results-In 38 patients with Afl, monophasic action potentials (MAPs) were recorded at the isthmus and either high or low right atrium (HRA, LRA) during overdrive pacing to 160 ms or to the initiation of AF, whichever came first. MAP duration measured at 90% repolarization was longer at the isthmus in all patients, and failed to shorten with rate, compared with the HRA (nϭ38) or LRA (nϭ5). In 20 patients who developed AF, progressive pacing first caused alternans of isthmus MAP duration and amplitude at mean cycle length of 219Ϯ45 ms, followed by AF at a mean onset cycle length of 184Ϯ38 ms. Subsets of this group showed spontaneous action potential duration alternans at the isthmus (11 of 20 patients) and 2:1 isthmus conduction block immediately preceding AF (4 of 20 patients). In the 18 patients who did not develop AF, MAP alternans was less common (9 of 18 patients; PϽ0.0003), and occurred only at faster pacing (cycle lengthϭ169Ϯ25 ms; PϽ0.05). Conclusions-In patients with typical Afl, action potential duration rate maladaptation at the isthmus may lead to action potential duration alternans and conduction block preceding the transition to AF. These isthmus characteristics may enable the spontaneous initiation of AF through wavefront fractionation and may explain the benefits of isthmus ablation in preventing AF recurrence.

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Section: Nonuniformity and Rate Maladaptation Of Atrial Apdmentioning

confidence: 99%

Alternans of Atrial Action Potentials During Atrial Flutter as a Precursor to Atrial Fibrillation

et al. 2002

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“…Atrial electrical remodeling has been evaluated in several animal models of rapid atrial pacing, 1,2,4,7,9,10,[20][21][22][23] which have documented the shortening of the AERP and prolongation in atrial conduction time, but few have reported the inhomogeneity in the process of atrial electrical remodeling. We previously reported that the shortening of the AERP was larger at the RAA and LA sites than at the other atrial sites when the rapid pacing was performed from the RAA site for 2 weeks.…”

Section: Inhomogeneity Of Electrical Remodelingmentioning

confidence: 99%

Effect of Pilsicainide on Atrial Electrophysiologic Properties in the Canine Rapid Atrial Stimulation Model. A Possible Suppressive Effect on Atrial Electrical Remodeling.

Kojima

Niwano

Moriguchi

et al. 2003

Circ J

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The heterogeneous process of atrial electrical remodeling (AER) in the canine rapid atrial stimulation model has been previously reported although it has been reported that a sodium channel blocker might suppress the shortening of the atrial effective refractory period (AERP), its effect on long-term electrical remodeling is unknown. In the present study, the effect of pilsicainide on AER was evaluated. The right atrial appendage (RAA) was paced at 400 beats/min for 2 weeks. In the RAA, Bachmann's bundle (BB), the right atrium near the inferior vena cava (IVC) and in the left atrium (LA), AERP, AERP dispersion (AERPd) and the inducibility of atrial fibrillation (AF) were evaluated at several time points of the pacing phase and the recovery phase (1 week). The same protocol was performed during the administration of pilsicainide (4.5 mg/kg per day) and the parameters were compared with the controls. In the control dogs, the AERP was significantly shortened by rapid pacing at all atrial sites studied and the AERP shortening ( AERP) was larger at the RAA and LA sites (p<0.03). However, pilsicainide decreased these AERPs at all 4 atrial sites. AERPd was increased during the pacing phase whereas it was decreased during the recovery phase in the control dogs. In contrast, this pacing-induced AERPd was attenuated by the administration of pilsicainide. The AF inducibility was highest at the LA site in both groups, and the inducibility was lower in the pilsicainide group than the control group at all atrial sites. During the rapid pacing phase, the ventricular heart rate was significantly lower in the pilsicainide group than the control because of intraatrial conduction block. In a canine rapid right atrial stimulation model, pilsicainide suppressed the shortening of the AERP at all atrial sites, possibly through the improvement of the hemodynamics as well as the action of the Na -Ca exchanger. (Circ J 2003; 67: 340 -346)

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“…Shortening of the atrial refractory period following establishment of atrial fibrillation and further lengthening after sinus rhythm restoration has already been demonstrated in humans as well as in animal models [2][3][4][5][10][11][12][13][23][24][25] . However, after long standing atrial fibrillation conversion to sinus rhythm, both lengthening and rate-adaptation of refractory period shows non-uniform time-dependent recovery in the atria, having been observed earlier on the right (hours) than References on the left atrium (days) thus, predisposing to dispersion of atrial refractoriness.…”

Section: (B) Mec (%) (C) Sec (%) (D) Met (Hz) (E) Set (Hz)mentioning

confidence: 91%

“…In animal models, the remodeling process has been demonstrated to be reversible after restoration of the sinus rhythm, and is characterized by progressive increase in both atrial conduction velocity and refractoriness (reversal remodeling) 1,2,10,11,13,22 . Recovery has also been demonstrated in human atria 3,[23][24][25][26] .…”

Section: Introductionmentioning

confidence: 99%

“…Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 . These changes can be induced by both rapid atrial pacing and AF itself, and have been termed "electrical remodeling" 2 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

Barbosa¹,

Benchimol-Barbosa²,

Bomfim³

et al. 2009

Arq. Bras. Cardiol.

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Background: Atrial fibrillation (AF) itself promotes electrophysiological changes, termed "electrical remodeling", facilitating its recurrence and maintenance. There is evidence that the remodeling process is reversible after restoration of the sinus rhythm (SR). However, the timing for the recovery of electrophysiological properties is still undefined.Objctive: The aim of this study was to assess the atrial electrical activation using P-wave signal-averaged electrocardiogram (P-SAECG) post-cardioversion of long-standing AF, focusing on the reversal remodeling process to identify the timing of the process stabilization.Methods: Subjects with lone persistent AF, eligible for cardioversion and successfully converted to SR, were enrolled at the study. SAECG was performed immediately after reversion to SR and repeated on days seven and thirty.Results: Of 31 subjects, nine presented early recurrence of atrial fibrillation, all of them in the first seven days postcardioversion; 22 remained in SR for at last one month and SAECG was obtained on days seven and thirty after cardioversion. In the latter, P-wave duration progressively abated from the first to the third SAECG (P-wave duration: 185.5±41.9 ms vs 171.7±40.5 ms vs 156.7±34.9 ms, respectively, first, second and third SAECG; p<0.001 for all matches). In the frequency domain analysis, spectral turbulence was not apparent in SAECG immediately postcardioversion, but sharply increased on day seven and remained unchanged on day thirty. Conclusion IntroductionAtrial fibrillation (AF) has been described as a selfperpetuating arrhythmia, which promotes electrophysiological changes in atrial tissue, facilitating its recurrence and maintenance [1][2][3][4][5] . Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 . These changes can be induced by both rapid atrial pacing and AF itself, and have been termed "electrical remodeling" 2 . The resultant electrophysiological abnormality is the presence of multiple wavelets around the atria, some of which circle back on them creating multiples reentry circuits, as proposed by Moe et al 19,20 in 1962 and 1964, and later confirmed by Allessie et al 21 in 1985.In animal models, the remodeling process has been demonstrated to be reversible after restoration of the sinus rhythm, and is characterized by progressive increase in both atrial conduction velocity and refractoriness (reversal remodeling) 1,2,10,11,13,22 . Recovery has also been demonstrated in human atria 3,[23][24][25][26] . On the other hand, a remarkab...

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Regional Differences in the Recovery Course of Tachycardia-Induced Changes of Atrial Electrophysiological Properties

Abstract: The LA had a slower recovery of tachycardia-induced changes of atrial electrophysiological properties, and this might play a critical role in initiation of AF.

Cited by 70 publications

References 26 publications

Alternans of Atrial Action Potentials During Atrial Flutter as a Precursor to Atrial Fibrillation

Alternans of Atrial Action Potentials During Atrial Flutter as a Precursor to Atrial Fibrillation

Effect of Pilsicainide on Atrial Electrophysiologic Properties in the Canine Rapid Atrial Stimulation Model. A Possible Suppressive Effect on Atrial Electrical Remodeling.

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

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