Circulation, Vol 84, 1662-1668, Copyright © 1991 by American Heart Association
K Kumagai, S Akimitsu, K Kawahira, F Kawanami, Y Yamanouchi, T Hiroki and K Arakawa
BACKGROUND. Although the electrophysiological mechanisms underlying
self-sustaining atrial fibrillation (AF) are unclear, recent studies
suggest that one requirement for reentry, slow conduction, is frequently
present in patients with AF. However, these observations limited to
paroxysmal AF may not necessarily apply to chronic AF. Therefore,
electrophysiological properties of the atrium and sinus nodal function in
chronic lone AF were evaluated. METHODS AND RESULTS. Electrophysiological
studies were performed after electrocardioversion in 12 patients with
chronic lone AF. Atrial enlargement was absent in the patients with AF.
Twelve patients without atrial arrhythmias served as the control group. The
patients with AF had a higher incidence of sinus nodal dysfunction, a
shorter atrial effective refractory period (215 +/- 19 msec versus 238 +/-
23 msec, p less than 0.02), and a longer P wave duration than control
patients (115 +/- 16 msec versus 86 +/- 16 msec, p less than 0.01). The
conduction delay zone was significantly greater in patients with AF (60 +/-
12 msec) than that in the control patients (8 +/- 13 msec, p less than
0.01), and the maximal conduction delay was also greater in the study
patients than those in the control group, both to the His bundle region (31
+/- 12 msec versus 10 +/- 15 msec, p less than 0.01) and to the coronary
sinus (41 +/- 15 msec versus 15 +/- 11 msec, p less than 0.01). The
fragmented atrial activity zone was wider in the study group (23 +/- 25
msec) than in control subjects (1.7 +/- 4 msec, p less than 0.02).
Repetitive atrial firing was observed in four patients with AF but it was
not seen in the control group. CONCLUSIONS. These electrophysiological
features, which are manifestations of the abnormal atrial
electrophysiology, would favor production of atrial reentry in chronic lone
AF.
ARTICLES
Electrophysiological properties in chronic lone atrial fibrillation
Cardiovascular Center, Kawanami Hospital, Fukuoka, Japan.
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