Temporal changes in atrial refractoriness following DC cardioversion of persistent atrial fibrillation in man

Spurrell, Philip A.R.; Kamalvand, Kayvan; Higson, Mike; Sulke, Neil

doi:10.1016/j.eupc.2004.01.006

Cited by 2 publications

(4 citation statements)

References 26 publications

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“…Recovery has also been demonstrated in human atria 3,[23][24][25][26] . On the other hand, a remarkable vulnerability to recurrence during post-cardioversion period has been observed while reverse remodeling is yet incomplete 23 .…”

Section: Introductionmentioning

confidence: 77%

“…Most studies about electrical atrial remodeling in humans have assessed subjects with and without overt cardiovascular disease [23][24][25]27 . Although micro structural atrial changes have been observed in lone AF 29 , gross and ultra-structural anatomic changes due to underlying cardiac disease, such as fibrosis, may persist indefinitely, despite the restoration to sinus rhythm and may be responsible for persistent electrophysiological abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

“…On the other hand, a remarkable vulnerability to recurrence during post-cardioversion period has been observed while reverse remodeling is yet incomplete 23 . However, the necessary time to completely restore atrial electrophysiological properties, especially the conduction velocity, is yet to be defined.The methods employed for electrophysiological analysis are usually invasive [23][24][25]27 and make consecutive analysis of the same subject difficult, generating limitations to determine the moment of complete reversal remodeling. Furthermore, little is known about the effects of antiarrhythmic drugs on the remodeling process, especially amiodarone, frequently used in order to facilitate cardioversion and maintain sinus rhythm 28 .…”

mentioning

confidence: 99%

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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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