| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1997;95:1231-1241.)
© 1997 American Heart Association, Inc.
Articles |
Configuration of Unipolar Atrial Electrograms During Electrically Induced Atrial Fibrillation in Humans
the Department of Physiology, Cardiology and Cardiopulmonary Surgery, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands.
Correspondence to Prof Dr M.A. Allessie, Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands.
Background During atrial fibrillation (AF), the atrium is activated by multiple wavelets that continuously change in size and direction. The aim of this study was to correlate the temporal variation in AF electrogram configuration with the varying spatial patterns of activation.
Methods and Results In a group of 25 Wolff-Parkinson-White patients undergoing cardiac surgery, the free wall of the right atrium was mapped (244 points) during electrically induced AF. The unipolar electrograms recorded during 4 seconds of AF were classified into four categories: (1) single deflections, (2) short-double potentials, (3) long-double potentials, and (4) fragmented potentials. The proportion of these four types of electrograms during AF was as follows: singles, 77±12%; short-doubles, 7±3%; long-doubles, 10±7%; and fragmented, 6±4%. Electrogram morphology was an indicator for rapid uniform conduction (single potentials; positive predictive value [PPV] of 0.96), collision (short-double potentials; PPV of 0.33), conduction block (long-double potentials; PPV of 0.84), and pivoting points or slow conduction (fragmented potentials; PPV of 0.87). In type I, II, and III AF, the proportion of long-double potentials was 4±2%, 12±3%, and 18±7% (P<.05); the proportion of fragmented complexes was 2±2%, 6±3%, and 10±4% (P<.05), respectively. During electrically induced and self-terminating episodes of AF, no preferential anatomic sites for double or fragmented potentials were found in the right atrium.
Conclusions The morphology of single unipolar electrograms during AF reflects the occurrence of various specific patterns of conduction. This might be used to differentiate between different types of AF and to identify regions with structural conduction disturbances involved in perpetuation of chronic AF.
Key Words: atrium • arrhythmia • fibrillation • mapping • reentry
This article has been cited by other articles:
 |
|
 |
|
  R. J. Hunter, I. Diab, G. Thomas, E. Duncan, D. Abrams, M. Dhinoja, S. Sporton, M. J. Earley, and R. J. Schilling Validation of a classification system to grade fractionation in atrial fibrillation and correlation with automated detection systems Europace, December 1, 2009; 11(12): 1587 - 1596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Niu, B. J. Scherlag, Z. Lu, M. Ghias, Y. Zhang, E. Patterson, T. W. Dasari, S. Zacharias, R. Lazzara, W. M. Jackman, et al. An Acute Experimental Model Demonstrating 2 Different Forms of Sustained Atrial Tachyarrhythmias Circ Arrhythm Electrophysiol, August 1, 2009; 2(4): 384 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M.S. de Groot Fractionated extracellular potentials: indicators of the arrhythmogenic substrate? Europace, August 1, 2009; 11(8): 975 - 976. [Full Text] [PDF]
|
|
|
|
 |
|
 R Balasubramaniam and P M Kistler Atrial fibrillation in heart failure: the chicken or the egg? Heart, April 1, 2009; 95(7): 535 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Oral, A. Chugh, K. Yoshida, J. F. Sarrazin, M. Kuhne, T. Crawford, N. Chalfoun, D. Wells, W. Boonyapisit, S. Veerareddy, et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. J. Am. Coll. Cardiol., March 3, 2009; 53(9): 782 - 789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. F. Berntsen, A. Cheng, H. Calkins, and R. D. Berger Evaluation of spatiotemporal organization of persistent atrial fibrillation with time- and frequency-domain measures in humans Europace, March 1, 2009; 11(3): 316 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Katritsis, E. Giazitzoglou, D. Sougiannis, E. Voridis, and S. S. Po Complex fractionated atrial electrograms at anatomic sites of ganglionated plexi in atrial fibrillation Europace, March 1, 2009; 11(3): 308 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al. Highlights of the Year in JACC 2008. J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398. [Full Text] [PDF]
|
|
|
|
|
|
I. Liuba and H. Walfridsson Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site Europace, October 1, 2008; 10(10): 1195 - 1204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rostock, D. Steven, B. Lutomsky, H. Servatius, I. Drewitz, H. Klemm, K. Mullerleile, R. Ventura, T. Meinertz, and S. Willems Atrial fibrillation begets atrial fibrillation in the pulmonary veins on the impact of atrial fibrillation on the electrophysiological properties of the pulmonary veins in humans. J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2153 - 2160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, M. Wright, M. Hocini, and P. Jais The Substrate Maintaining Persistent Atrial Fibrillation Circ Arrhythm Electrophysiol, April 1, 2008; 1(1): 2 - 5. [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahashi, M. D. O'Neill, M. Hocini, R. Dubois, S. Matsuo, S. Knecht, S. Mahapatra, K.-T. Lim, P. Jais, A. Jonsson, et al. Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1003 - 1010. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Narayan and M. R. Franz Quantifying fractionation and rate in human atrial fibrillation using monophasic action potentials: implications for substrate mapping Europace, November 1, 2007; 9(suppl_6): vi89 - vi95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Lellouche, E. Buch, A. Celigoj, C. Siegerman, D. Cesario, C. De Diego, A. Mahajan, N. G. Boyle, I. Wiener, A. Garfinkel, et al. Functional Characterization of Atrial Electrograms in Sinus Rhythm Delineates Sites of Parasympathetic Innervation in Patients With Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1324 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 K. Nademanee Trials and Travails of Electrogram-Guided Ablation of Chronic Atrial Fibrillation Circulation, May 22, 2007; 115(20): 2592 - 2594. [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, E. Good, A. Wimmer, S. Dey, N. Gadeela, S. Sankaran, T. Crawford, J. F. Sarrazin, M. Kuhne, et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms Circulation, May 22, 2007; 115(20): 2606 - 2612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Lemola, M. Ting, P. Gupta, J. N. Anker, A. Chugh, E. Good, S. Reich, D. Tschopp, P. Igic, D. Elmouchi, et al. Effects of Two Different Catheter Ablation Techniques on Spectral Characteristics of Atrial Fibrillation J. Am. Coll. Cardiol., July 18, 2006; 48(2): 340 - 348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-J. Lin, C.-T. Tai, T. Kao, H.-W. Tso, S. Higa, H.-M. Tsao, S.-L. Chang, M.-H. Hsieh, and S.-A. Chen Frequency Analysis in Different Types of Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1401 - 1407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Pennington The Impact of New Technology on Cardiothoracic Surgical Practice Ann. Thorac. Surg., January 1, 2006; 81(1): 10 - 18. [Full Text] [PDF]
|
|
|
|
|
|
B. L. Hoppe, A. M. Kahn, G. K. Feld, A. Hassankhani, and S. M. Narayan Separating Atrial Flutter From Atrial Fibrillation With Apparent Electrocardiographic Organization Using Dominant and Narrow F-Wave Spectra J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2079 - 2087. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. U. Klein and S. Reek "The Older the Broader": Electrogram Characteristics Help Identify the Critical Isthmus During Catheter Ablation of Postinfarct Ventricular Tachycardia J. Am. Coll. Cardiol., August 16, 2005; 46(4): 675 - 677. [Full Text] [PDF]
|
|
|
|
|
|
B. J. Scherlag, W. Yamanashi, U. Patel, R. Lazzara, and W. M. Jackman Autonomically Induced Conversion of Pulmonary Vein Focal Firing Into Atrial Fibrillation J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1878 - 1886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Narayan, A. Hassankhani, G. K. Feld, and V. Bhargava Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1269 - 1279. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Khargi, B. A. Hutten, B. Lemke, and T. Deneke Surgical treatment of atrial fibrillation; a systematic review Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 258 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sahadevan, K. Ryu, L. Peltz, C. M. Khrestian, R. W. Stewart, A. H. Markowitz, and A. L. Waldo Epicardial Mapping of Chronic Atrial Fibrillation in Patients: Preliminary Observations Circulation, November 23, 2004; 110(21): 3293 - 3299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, K. Lemola, P. Cheung, B. Hall, E. Good, J. Han, K. Tamirisa, F. Bogun, F. Pelosi Jr, et al. Noninducibility of Atrial Fibrillation as an End Point of Left Atrial Circumferential Ablation for Paroxysmal Atrial Fibrillation: A Randomized Study Circulation, November 2, 2004; 110(18): 2797 - 2801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, P. Sanders, M. Hocini, L.-F. Hsu, D. C. Shah, C. Scavee, Y. Takahashi, M. Rotter, J.-L. Pasquie, S. Garrigue, et al. Changes in Atrial Fibrillation Cycle Length and Inducibility During Catheter Ablation and Their Relation to Outcome Circulation, June 22, 2004; 109(24): 3007 - 3013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nademanee, J. McKenzie, E. Kosar, M. Schwab, B. Sunsaneewitayakul, T. Vasavakul, C. Khunnawat, and T. Ngarmukos A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2044 - 2053. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nair, P. Shah, R. Batra, M. Kumar, J. Mohan, U. Kaul, and R. Arora Chronic Atrial Fibrillation in Patients With Rheumatic Heart Disease: Mapping and Radiofrequency Ablation of Flutter Circuits Seen at Initiation After Cardioversion Circulation, August 14, 2001; 104(7): 802 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-T. Tai, S.-A. Chen, J.-W. Tzeng, B. I. Kuo, Y.-A. Ding, M.-S. Chang, and L.-Y. Shyu Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1651 - 1657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gaita, L. Calo, R. Riccardi, L. Garberoglio, M. Scaglione, G. Licciardello, L. Coda, P. Di Donna, M. Bocchiardo, D. Caponi, et al. Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation J. Am. Coll. Cardiol., February 1, 2001; 37(2): 534 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
R. Ammer, G.u. Lehmann, A. Plewan, K. Puetter, and E. Alt Marked reduction in atrial defibrillation thresholds with repeated internal cardioversion J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1569 - 1576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sun, E. O. Velipasaoglu, D. E. Wu, H. A. Kopelen, W. A. Zoghbi, W. H. Spencer III, and D. S. Khoury Simultaneous Multisite Mapping of the Right and the Left Atrial Septum in the Canine Intact Beating Heart Circulation, July 20, 1999; 100(3): 312 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gaita, R. Riccardi, L. Calo, M. Scaglione, L. Garberoglio, R. Antolini, M. Kirchner, F. Lamberti, and E. Richiardi Atrial Mapping and Radiofrequency Catheter Ablation in Patients With Idiopathic Atrial Fibrillation : Electrophysiological Findings and Ablation Results Circulation, June 2, 1998; 97(21): 2136 - 2145. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Holm, S. Pehrson, M. Ingemansson, L. Sornmo, R. Johansson, L. Sandhall, M. Sunemark, B. Smideberg, C. Olsson, and S.B. Olsson Non-invasive assessment of the atrial cycle length during atrial fibrillation in man: introducing, validating and illustrating a new ECG method Cardiovasc Res, April 1, 1998; 38(1): 69 - 81. [Abstract] [Full Text] [PDF]
|
|