(Circulation. 1998;98:2860-2865.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports* |
Electrophysiological Characteristics of the Human Atria After Cardioversion of Persistent Atrial Fibrillation
From the Department of Cardiology, San Filippo Neri Hospital, Arrhythmia Control Unit (M.V.), La Sapienza University, Rome, Italy.
Correspondence to Claudio Pandozi, MD, Via Madonna di Fatima, 22, 00147, Rome, Italy. E-mail mvillani{at}uniroma1.it
Background—In animal models, induced atrial fibrillation shortens the atrial effective refractory period (ERP) and reverses its physiological adaptation to rate. It is not clear whether this process, known as "electrical remodeling," occurs in humans.
Methods and Results—We determined the ERPs, at 5 pacing cycle
lengths (300 to 700 ms) and in 5 right atrial sites, after internal
cardioversion of chronic atrial fibrillation in 25 patients (14 in
pharmacological washout and 11 on amiodarone). The ERPs were
195.5±18.8 ms in the washout and 206.3±17.9 ms in the
amiodarone patients (P<0.0001). ERPs were
closely correlated with the stimulation rates (r=0.95 in
the washout and r=0.94 in the amiodarone group),
and slope values indicating a normal (
0.07) or nearly normal (0.05 to
0.06) adaptation of ERP to rate were found in 77% of the 84 paced
sites. The mean ERP was shorter in the lateral wall (198.1±17.9 ms)
than in the atrial roof (203.3±21.5 ms) and in the septum (210.5±20.0
ms) (P<0.03). After 4 weeks of sinus rhythm, the mean
ERP, determined again in 8 patients (4 in wash-out and 4 on
amiodarone), was significantly increased compared with the
basal study (221.4±21.4 versus 197.8±18.3 ms,
P<0.0001).
Conclusions—After cardioversion of chronic atrial fibrillation, (1) atrial ERP adaptation to rate was normal or nearly normal in the majority of the cases, (2) a significant dispersion of refractoriness between different right atrial sites was present, and (3) ERPs were significantly increased after 4 weeks of sinus rhythm in both washout and amiodarone patients.
Key Words: fibrillation • remodeling • electrophysiology • atrium
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