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(Circulation. 1996;94:1600-1606.)
© 1996 American Heart Association, Inc.
Articles |
Effect of Atrial Fibrillation on Atrial Refractoriness in Humans
the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor.
Correspondence to Fred Morady, MD, University of Michigan Hospital, Division of Cardiology, B1-F245, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0022.
BackgroundThe acute effect of atrial fibrillation (AF) on the atrial effective refractory period (ERP) in humans is unknown.
Methods and Results In 20 patients without structural heart disease, the atrial ERP was measured before and after pacing-induced AF at drive cycle lengths of 350 and 500 ms. Immediately after spontaneous AF conversion, the post-AF ERP was measured. The pre-AF ERPs at 350 and 500 ms were 206±23 and 216±17 ms, respectively. The time to spontaneous conversion of AF was 7.3±1.9 minutes. The first post-AF ERPs at drive cycle lengths of 350 and 500 ms were 175±30 ms (P<.0001 versus pre-AF) and 191±30 ms (P<.0001 versus pre-AF), respectively. The post-AF ERP returned to the pre-AF ERP value after a mean of 8.4±0.3 minutes. In 15 patients, during the determination of the post-AF ERP, secondary episodes of AF lasting 1±1.5 minutes were reinduced 6±3 times per patient. There was a significant inverse logarithmic relationship between the time to reinduction of AF and the duration of secondary episodes of AF (P<.0001, r=.5).
Conclusions In humans, several minutes of induced AF is sufficient to shorten the ERP for up to 
8 minutes. The temporal recovery of the ERP is reflected in progressively shorter episodes of reinduced AF. These data imply that AF transiently shortens the atrial wavelength and suggest a mechanism by which AF may perpetuate itself.
Key Words: fibrillation • atrium • electrophysiology
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C. Pandozi, L. Bianconi, M. Villani, G. Gentilucci, A. Castro, G. Altamura, A. P. Jesi, F. Lamberti, F. Ammirati, and M. Santini Electrophysiological Characteristics of the Human Atria After Cardioversion of Persistent Atrial Fibrillation Circulation, December 22, 1998; 98(25): 2860 - 2865. [Abstract] [Full Text] [PDF]
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N. S PETERS Atrial fibrillation: towards an understanding of initiation, perpetuation, and specific treatment Heart, December 1, 1998; 80(6): 533 - 534. [Full Text]
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S. Fareh, C. Villemaire, and S. Nattel Importance of Refractoriness Heterogeneity in the Enhanced Vulnerability to Atrial Fibrillation Induction Caused by Tachycardia-Induced Atrial Electrical Remodeling Circulation, November 17, 1998; 98(20): 2202 - 2209. [Abstract] [Full Text] [PDF]
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M. J. Janse, T. Opthof, and A. G. Kleber Animal models of cardiac arrhythmias Cardiovasc Res, July 1, 1998; 39(1): 165 - 177. [Full Text] [PDF]
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W.-C. Yu, S.-A. Chen, S.-H. Lee, C.-T. Tai, A.-N. Feng, B. I.-T. Kuo, Y.-A. Ding, and M.-S. Chang Tachycardia-Induced Change of Atrial Refractory Period in Humans : Rate Dependency and Effects of Antiarrhythmic Drugs Circulation, June 16, 1998; 97(23): 2331 - 2337. [Abstract] [Full Text] [PDF]
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M. C. E. F. Wijffels, C. J. H. J. Kirchhof, R. Dorland, J. Power, and M. A. Allessie Electrical Remodeling due to Atrial Fibrillation in Chronically Instrumented Conscious Goats : Roles of Neurohumoral Changes, Ischemia, Atrial Stretch, and High Rate of Electrical Activation Circulation, November 18, 1997; 96(10): 3710 - 3720. [Abstract] [Full Text]
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E. G. Daoud, B. P. Knight, R. Weiss, M. Bahu, W. Paladino, R. Goyal, K. C. Man, S. A. Strickberger, and F. Morady Effect of Verapamil and Procainamide on Atrial Fibrillation–Induced Electrical Remodeling in Humans Circulation, September 2, 1997; 96(5): 1542 - 1550. [Abstract] [Full Text]
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 D. R. Van Wagoner, A. L. Pond, P. M. McCarthy, J. S. Trimmer, and J. M. Nerbonne Outward K+ Current Densities and Kv1.5 Expression Are Reduced in Chronic Human Atrial Fibrillation Circ. Res., June 19, 1997; 80(6): 772 - 781. [Abstract] [Full Text]
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D. P. Zipes Electrophysiological Remodeling of the Heart Owing to Rate Circulation, April 1, 1997; 95(7): 1745 - 1748. [Full Text]
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