Circulation, Vol 89, 1665-1680, Copyright © 1994 by American Heart Association
KT Konings, CJ Kirchhof, JR Smeets, HJ Wellens, OC Penn and MA Allessie
BACKGROUND: Mapping studies in animals have suggested that atrial
fibrillation (AF) is based on multiple reentering wavelets. Little
information is available about the patterns of activation during AF in
humans. The objective of the present study was to reconstruct and classify
the patterns of human right atrial (RA) activation during electrically
induced AF. METHODS AND RESULTS: AF was induced by rapid atrial pacing in
25 patients with Wolff-Parkinson-White syndrome undergoing surgery for
interruption of their accessory pathway(s). The free wall of the RA was
mapped using a spoon-shaped electrode containing 244 unipolar electrodes.
The activation of the RA during AF showed large interindividual
differences. Based on the complexity of atrial activation, three types of
AF were defined. In type I (40% of patients), single broad wave fronts
propagated uniformly across the RA. Type II (32%) was characterized by one
or two nonuniformly conducting wavelets, whereas in type III (28%),
activation of the RA was highly fragmented and showed three or more
different wavelets that frequently changed their direction of propagation
as a result of numerous arcs of functional conduction block. There were
significant differences (P < .05) among the three types of AF in median
intervals (174 +/- 28, 150 +/- 14, and 136 +/- 16 milliseconds), variation
in AF intervals (P5-95) (54 +/- 25, 94 +/- 21, and 104 +/- 22
milliseconds), incidence of electrical inactivity (42 +/- 11%, 21 +/- 4%,
and 8 +/- 4%) and reentry (3 +/- 7%, 36 +/- 28%, and 99 +/- 36%), and
average conduction velocity during AF (61 +/- 6, 54 +/- 4, and 38 +/- 10
cm/s). CONCLUSIONS: During pacing-induced AF in humans, the RA is activated
by one or multiple wavelets propagating in different directions. Three
types of RA activation during AF were identified. From type I to type III,
the frequency and irregularity of AF increased, and the incidence of
continuous electrical activity and reentry became higher. These various
types of AF in humans appear to be characterized by different numbers and
dimensions of the intra-atrial reentrant circuits.
ARTICLES
High-density mapping of electrically induced atrial fibrillation in humans
Department of Physiology, Cardiovascular Research Institute Maastricht, University of Limburg, The Netherlands.
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A Nabar, L M Rodriguez, C Timmermans, R van Mechelen, and H J J Wellens Class IC antiarrhythmic drug induced atrial flutter: electrocardiographic and electrophysiological findings and their importance for long term outcome after right atrial isthmus ablation Heart, April 1, 2001; 85(4): 424 - 429. [Abstract] [Full Text]
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D. Katritsis Cavotricuspid isthmus ablation and atrial fibrillation Eur. Heart J., December 2, 2000; 21(24): 2080 - 2080. [PDF]
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H. J. Sih, D. P. Zipes, E. J. Berbari, D. E. Adams, and J. E. Olgin Differences in organization between acute and chronic atrial fibrillation in dogs J. Am. Coll. Cardiol., September 1, 2000; 36(3): 924 - 931. [Abstract] [Full Text] [PDF]
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A. Bollmann Quantification of electrical remodeling in human atrial fibrillation Cardiovasc Res, August 1, 2000; 47(2): 207 - 209. [Full Text] [PDF]
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M. C. E. F. Wijffels, R. Dorland, F. Mast, and M. A. Allessie Widening of the Excitable Gap During Pharmacological Cardioversion of Atrial Fibrillation in the Goat : Effects of Cibenzoline, Hydroquinidine, Flecainide, and d-Sotalol Circulation, July 11, 2000; 102(2): 260 - 267. [Abstract] [Full Text] [PDF]
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C.-F. Tsai, C.-T. Tai, M.-H. Hsieh, W.-S. Lin, W.-C. Yu, K.-C. Ueng, Y.-A. Ding, M.-S. Chang, and S.-A. Chen Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava : Electrophysiological Characteristics and Results of Radiofrequency Ablation Circulation, July 4, 2000; 102(1): 67 - 74. [Abstract] [Full Text] [PDF]
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D. Li, A. Benardeau, and S. Nattel Contrasting Efficacy of Dofetilide in Differing Experimental Models of Atrial Fibrillation Circulation, July 4, 2000; 102(1): 104 - 112. [Abstract] [Full Text] [PDF]
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F. Gaita, R. Gallotti, L. Calo, E. Manasse, R. Riccardi, L. Garberoglio, F. Nicolini, M. Scaglione, P. Di Donna, D. Caponi, et al. Limited posterior left atrial cryoablation in patients with chronic atrial fibrillation undergoing valvular heart surgery J. Am. Coll. Cardiol., July 1, 2000; 36(1): 159 - 166. [Abstract] [Full Text] [PDF]
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M. M. Scheinman Mechanisms of atrial fibrillation: is a cure at hand? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1687 - 1692. [Abstract] [Full Text] [PDF]
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F. J. Chorro, J. Canoves, J. Guerrero, L. Mainar, J. Sanchis, L. Such, and V. Lopez-Merino Alteration of Ventricular Fibrillation by Flecainide, Verapamil, and Sotalol : An Experimental Study Circulation, April 4, 2000; 101(13): 1606 - 1615. [Abstract] [Full Text] [PDF]
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R.J Schilling, A.H Kadish, N.S Peters, J Goldberger, and D.W. Davies Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter Eur. Heart J., April 1, 2000; 21(7): 550 - 564. [Abstract] [PDF]
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K. Shinagawa, H. Mitamura, A. Takeshita, T. Sato, H. Kanki, S. Takatsuki, and S. Ogawa Determination of refractory periods and conduction velocity during atrial fibrillation using atrial capture in dogs: Direct assessment of the wavelength and its modulation by a sodium channel blocker, pilsicainide J. Am. Coll. Cardiol., January 1, 2000; 35(1): 246 - 253. [Abstract] [Full Text] [PDF]
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M.P. Ingemansson, B. Smideberg, and S.B. Olsson Intravenous MgSO4alone and in combination with glucose, insulin and potassium (GIK) prolong the atrial cycle length in chronic atrial fibrillation Europace, January 1, 2000; 2(2): 106 - 114. [Abstract] [PDF]
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S.-A. Chen, M.-H. Hsieh, C.-T. Tai, C.-F. Tsai, V. S. Prakash, W.-C. Yu, T.-L. Hsu, Y.-A. Ding, and M.-S. Chang Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Pulmonary Veins : Electrophysiological Characteristics, Pharmacological Responses, and Effects of Radiofrequency Ablation Circulation, November 2, 1999; 100(18): 1879 - 1886. [Abstract] [Full Text] [PDF]
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V. Ducceschi, A. D'Andrea, B. Liccardo, A. Alfieri, B. Sarubbi, M. De Feo, L. Santangelo, and M. Cotrufo Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery surgery Eur. J. Cardiothorac. Surg., October 1, 1999; 16(4): 435 - 439. [Abstract] [Full Text] [PDF]
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A. Bollmann, K. Sonne, H.-D. Esperer, I. Toepffer, J. J Langberg, and H. U Klein Non-invasive assessment of fibrillatory activity in patients with paroxysmal and persistent atrial fibrillation using the Holter ECG Cardiovasc Res, October 1, 1999; 44(1): 60 - 66. [Abstract] [Full Text] [PDF]
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B. Schumacher, W. Jung, H. Schmidt, C. Fischenbeck, T. Lewalter, A. Hagendorff, H. Omran, C. Wolpert, and B. Luderitz Transverse conduction capabilities of the crista terminalis in patients with atrial flutter and atrial fibrillation J. Am. Coll. Cardiol., August 1, 1999; 34(2): 363 - 373. [Abstract] [Full Text] [PDF]
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W.-C. Yu, S.-H. Lee, C.-T. Tai, C.-F. Tsai, M.-H. Hsieh, C.-C. Chen, Y.-A. Ding, M.-S. Chang, and S.-A. Chen Reversal of atrial electrical remodeling following cardioversion of long-standing atrial fibrillation in man Cardiovasc Res, May 1, 1999; 42(2): 470 - 476. [Abstract] [Full Text] [PDF]
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A. Kadish, J. Hauck, B. Pederson, G. Beatty, and C. Gornick Mapping of Atrial Activation With a Noncontact, Multielectrode Catheter in Dogs Circulation, April 13, 1999; 99(14): 1906 - 1913. [Abstract] [Full Text] [PDF]
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M. Holm, R. Johansson, B. Smideberg, C. Luhrs, and S.B. Olsson Effect of cardiac exposure by median sternotomy on atrial fibrillation cycle length Europace, January 1, 1999; 1(4): 248 - 257. [Abstract] [PDF]
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