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(Circulation. 1995;92:1954-1968.)
© 1995 American Heart Association, Inc.
Articles |
Atrial Fibrillation Begets Atrial Fibrillation
A Study in Awake Chronically Instrumented Goats
From the Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University of Limburg, The Netherlands.
Correspondence to Prof Dr M.A. Allessie, Department of Physiology, Cardiovascular Research Institute Maastricht, University of Limburg, PO Box 616, 6200 MD Maastricht, The Netherlands.
Background In this study we tested the hypothesis that atrial fibrillation (AF) causes electrophysiological changes of the atrial myocardium which might explain the progressive nature of the arrhythmia.
Methods and Results Twelve goats were chronically instrumented with multiple electrodes sutured to the epicardium of both atria. Two to 3 Weeks after implantation, the animals were connected to a fibrillation pacemaker which artificially maintained AF. Whereas during control episodes of AF were short lasting (6±3 seconds), artificial maintenance of AF resulted in a progressive increase in the duration of AF to become sustained (>24 hours) after 7.1±4.8 days (10 of 11 goats). During the first 24 hours of AF the median fibrillation interval shortened from 145±18 to 108±8 ms and the inducibility of AF by a single premature stimulus increased from 24% to 76%. The atrial effective refractory period (AERP) shortened from 146±19 to 95±20 ms (-35%) (S1S1, 400 ms). At high pacing rates the shortening was less (-12%), pointing to a reversion of the normal adaptation of the AERP to heart rate. In 5 goats, after 2 to 4 weeks of AF, sinus rhythm was restored and all electrophysiological changes were found to be reversible within 1 week.
Conclusions Artificial maintenance of AF leads to a marked shortening of AERP, a reversion of its physiological rate adaptation, and an increase in rate, inducibility and stability of AF. All these changes were completely reversible within 1 week of sinus rhythm.
Key Words: atrium • fibrillation • remodeling • wavelength
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S. Petrutiu, A. V. Sahakian, and S. Swiryn Abrupt changes in fibrillatory wave characteristics at the termination of paroxysmal atrial fibrillation in humans Europace, July 1, 2007; 9(7): 466 - 470. [Abstract] [Full Text] [PDF]
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Y. Blaauw, U. Schotten, A. van Hunnik, H.R. Neuberger, and M.A. Allessie Cardioversion of persistent atrial fibrillation by a combination of atrial specific and non-specific class III drugs in the goat Cardiovasc Res, July 1, 2007; 75(1): 89 - 98. [Abstract] [Full Text] [PDF]
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D. Jeyaraj, L. D. Wilson, J. Zhong, C. Flask, J. E. Saffitz, I. Deschenes, X. Yu, and D. S. Rosenbaum Mechanoelectrical Feedback as Novel Mechanism of Cardiac Electrical Remodeling Circulation, June 26, 2007; 115(25): 3145 - 3155. [Abstract] [Full Text] [PDF]
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A. Jahangir, V. Lee, P. A. Friedman, J. M. Trusty, D. O. Hodge, S. L. Kopecky, D. L. Packer, S. C. Hammill, W.-K. Shen, and B. J. Gersh Long-Term Progression and Outcomes With Aging in Patients With Lone Atrial Fibrillation: A 30-Year Follow-Up Study Circulation, June 19, 2007; 115(24): 3050 - 3056. [Abstract] [Full Text] [PDF]
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H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]
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A. K Nergardh, M. Rosenqvist, R. Nordlander, and M. Frick Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study Eur. Heart J., June 1, 2007; 28(11): 1351 - 1357. [Abstract] [Full Text] [PDF]
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E. Saygili, O. R. Rana, E. Saygili, H. Reuter, K. Frank, R. H. G. Schwinger, J. Muller-Ehmsen, and C. Zobel Losartan prevents stretch-induced electrical remodeling in cultured atrial neonatal myocytes Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2898 - H2905. [Abstract] [Full Text] [PDF]
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