(Circulation. 1999;100:1894-1900.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Electrical Remodeling of the Atria Following Loss of Atrioventricular Synchrony
A Long-Term Study in Humans
Presented in part and received first prize at The NASPE Young Investigators' Clinical Research Competition at the 19th Annual Scientific Sessions, San Diego, California, May 1998; presented in part at the 46th Annual Scientific Sessions of the Cardiac Society of Australia and New Zealand, Perth, Australial, August 1998; and won the Ralph Reader Prize for Clinical Research at these Sessions.
From The Department of Cardiology, The Royal Melbourne Hospital (P.B.S., H.G.M., J.K.V., S.J., J.M.K.), and The Department of Medicine, University of Melbourne (P.B.S., J.M.K.), Melbourne, Australia.
Correspondence to Dr Jonathan M. Kalman, Department of Cardiology, The Royal Melbourne Hospital, Victoria, 3050, Australia. E-mail jon.kalman{at}nwhcn.org.au
Background—Evidence suggests that an increased incidence of atrial fibrillation occurs in patients undergoing single-chamber ventricular pacing (VVI) when compared with those undergoing single-chamber atrial pacing (AAI) or those having dual-chamber atrioventricular pacing (DDD). The mechanism for this is unknown. We hypothesized that long-term loss of atrioventricular (AV) synchrony leads to atrial electrical remodeling: a potential explanation for this difference.
Methods and Results—The study was a prospective, randomized comparison between 18 patients paced in VVI mode and 12 patients paced in DDD mode for 3 months. Under autonomic blockade, effective refractory periods (ERPs) from the lateral right atrium (RA), RA appendage, RA septum, and coronary sinus–corrected sinus node recovery times (cSNRTs), as well as P-wave duration (PWD), and biatrial diameters were measured at baseline and 3 months. The VVI group was then programmed to DDD pacing and reevaluated after a further 3 months. After long-term VVI pacing, ERPs at all 4 atrial sites increased significantly in a nonuniform fashion in association with biatrial dilatation. PWD and cSNRTs also prolonged significantly. With the reestablishment of AV synchrony, ERPs, PWD, cSNRTs, and biatrial dimensions returned to baseline levels. In the 12 patients who underwent long-term DDD pacing from baseline, no significant changes in atrial electrophysiology or biatrial dimensions were demonstrated.
Conclusions—Long-term loss of AV synchrony induced by VVI pacing is associated with atrial electrical remodeling, which is reversible after the reestablishment of AV synchrony with DDD pacing. This process may be partly responsible for the higher incidence of atrial fibrillation in patients undergoing VVI pacing compared with AV sequential pacing.
Key Words: atrium • electrophysiology • fibrillation • pacemakers • remodeling
This article has been cited by other articles:
 |
|
 |
|
  S. P. Bhavnani, C. I. Coleman, C. M. White, C. A. Clyne, R. Yarlagadda, D. Guertin, and J. Kluger Association between statin therapy and reductions in atrial fibrillation or flutter and inappropriate shock therapy Europace, July 1, 2008; 10(7): 854 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. C. Roberts-Thomson, I. H. Stevenson, P. M. Kistler, H. M. Haqqani, J. C. Goldblatt, P. Sanders, and J. M. Kalman Anatomically Determined Functional Conduction Delay in the Posterior Left Atrium: Relationship to Structural Heart Disease J. Am. Coll. Cardiol., February 26, 2008; 51(8): 856 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. C. Van Gelder and M. E.W. Hemels The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm Europace, November 1, 2006; 8(11): 943 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Israel The role of pacing mode in the development of atrial fibrillation. Europace, February 1, 2006; 8(2): 89 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Swissa, S. Zhou, O. Paz, M. C. Fishbein, L. S. Chen, and P.-S. Chen Canine model of paroxysmal atrial fibrillation and paroxysmal atrial tachycardia Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H1851 - H1857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-R. Neuberger, U. Schotten, S. Verheule, S. Eijsbouts, Y. Blaauw, A. van Hunnik, and M. Allessie Development of a Substrate of Atrial Fibrillation During Chronic Atrioventricular Block in the Goat Circulation, January 4, 2005; 111(1): 30 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, P. M. Kistler, J. B. Morton, S. J. Spence, and J. M. Kalman Remodeling of Sinus Node Function in Patients With Congestive Heart Failure: Reduction in Sinus Node Reserve Circulation, August 24, 2004; 110(8): 897 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Kistler, P. Sanders, S. P. Fynn, I. H. Stevenson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrophysiologic and electroanatomic changes in the human atrium associated with age J. Am. Coll. Cardiol., July 7, 2004; 44(1): 109 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L Kristensen, J C Nielsen, P T Mortensen, O L Pedersen, A K Pedersen, and H R Andersen Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome Heart, June 1, 2004; 90(6): 661 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, J. B. Morton, P. M. Kistler, S. J. Spence, N. C. Davidson, A. Hussin, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrophysiological and Electroanatomic Characterization of the Atria in Sinus Node Disease: Evidence of Diffuse Atrial Remodeling Circulation, March 30, 2004; 109(12): 1514 - 1522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, J. B. Morton, N. C. Davidson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrical Remodeling of the Atria in Congestive Heart Failure: Electrophysiological and Electroanatomic Mapping in Humans Circulation, September 23, 2003; 108(12): 1461 - 1468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hocini, P. Sanders, I. Deisenhofer, P. Jais, L.-F. Hsu, C. Scavee, R. Weerasoriya, F. Raybaud, L. Macle, D. C. Shah, et al. Reverse Remodeling of Sinus Node Function After Catheter Ablation of Atrial Fibrillation in Patients With Prolonged Sinus Pauses Circulation, September 9, 2003; 108(10): 1172 - 1175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. O. Sweeney, A. S. Hellkamp, K. A. Ellenbogen, A. J. Greenspon, R. A. Freedman, K. L. Lee, and G. A. Lamas Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction Circulation, June 17, 2003; 107(23): 2932 - 2937. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Verheule, E. Wilson, T. Everett IV, S. Shanbhag, C. Golden, and J. Olgin Alterations in Atrial Electrophysiology and Tissue Structure in a Canine Model of Chronic Atrial Dilatation Due to Mitral Regurgitation Circulation, May 27, 2003; 107(20): 2615 - 2622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Morton, P. Sanders, J. K. Vohra, P. B. Sparks, J. G. Morgan, S. J. Spence, L. E. Grigg, and J. M. Kalman Effect of Chronic Right Atrial Stretch on Atrial Electrical Remodeling in Patients With an Atrial Septal Defect Circulation, April 8, 2003; 107(13): 1775 - 1782. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. LI, H. B XIAO, M. Y HENEIN, J. SOMERVILLE, and D. G GIBSON Progressive ECG changes before the onset of atrial flutter in adult congenital heart disease patients Heart, June 1, 2001; 85(6): 703 - 703. [Full Text]
|
|