(Circulation. 2000;102:1807.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Electrical Remodeling of the Atria Associated With Paroxysmal and Chronic Atrial Flutter
Presented in part at NASPE 20th Annual Scientific Sessions, Toronto, Canada, May 1999.
From Royal Melbourne Hospital Department of Cardiology and the University of Melbourne, Department of Medicine (P.B.S., J.M.K.), Melbourne, Australia.
Correspondence to Dr Jonathan Kalman, Department of Cardiology, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria 3050 Australia. E-mail jon.kalman{at}nwhcn.org.au
Background—Atrial electrical remodeling may be important for the initiation and perpetuation of atrial arrhythmias. Whether paroxysmal atrial flutter (AFL) and chronic AFL cause electrical remodeling of the atria has not been conclusively determined.
Methods and Results—Before radiofrequency ablation of paroxysmal
AFL, 15 patients in sinus rhythm were evaluated under autonomic
blockade. Lateral right atrial (LRA) effective refractory periods
(ERPs) at 600 and 450 ms were measured before and at 1-minute intervals
for 10 minutes after spontaneous or pace termination of a 5- to
10-minute period of induced AFL. In 10 patients with chronic AFL, LRA,
septal, and coronary sinus (CS) ERPs and corrected sinus node
recovery times (cSNRTs) at 600 and 450 ms were measured under autonomic
blockade 15 minutes, 30 minutes, and 3 weeks after termination of
chronic AFL by ablation. In the paroxysmal AFL group, LRA ERPs
decreased by 18% at 600 ms and 12% at 450 ms (P<0.01)
after induced AFL and recovered to baseline over 
5 minutes. Atrial
fibrillation developed during AFL in 3 patients and during ERP testing
in 3 patients when refractoriness was at its nadir. In the chronic AFL
group, LRA, septal, and CS ERPs at 3 weeks were significantly greater
than at 15 and 30 minutes after termination of chronic AFL at both
cycle lengths (P<0.01). Three weeks after ablation,
cSNRT decreased 35% at 600 ms (P<0.05) and decreased
44% at 450 ms (P<0.05). Both ERPs and cSNRTs measured
15 and 30 minutes after ablation of chronic AFL were not significantly
different.
Conclusions—Both paroxysmal AFL and chronic AFL cause reversible electrical remodeling of the atria but demonstrate different time courses of recovery.
Key Words: ablation • fibrillation • atrial flutter • remodeling
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