Paroxysmal Lone Atrial Fibrillation Is Associated With an Abnormal Atrial Substrate. Characterizing the "Second Factor"

Martin K. Stiles, Bobby John, Christopher X. Wong, Pawel Kuklik, Anthony G. Brooks, Dennis H. Lau, Hany Dimitri, Kurt C. Roberts-Thomson, Lauren Wilson, Paolo De Sciscio, Glenn D. Young, Prashanthan Sanders

Research output: Contribution to journalArticle

243 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine whether patients with paroxysmal "lone" atrial fibrillation (AF) have an abnormal atrial substrate. Background: While "AF begets AF," prompt termination to prevent electrical remodeling does not prevent disease progression. Methods: Twenty-five patients with paroxysmal lone AF, without arrhythmia in the week prior, and 25 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium (RA), crista terminalis, coronary sinus, septal RA, and sequentially within the left atrium (LA) determined the effective refractory period (ERP) at 10 sites, conduction time along linear catheters, and conduction characteristics at the crista terminalis. Bi-atrial electroanatomic maps were created to determine regional differences in conduction velocity and voltage. Results: Patients with AF demonstrated the following compared with reference patients: larger atrial volumes (RA: 94 ± 18 ml vs. 69 ± 9 ml, p = 0.003; LA: 99 ± 19 ml vs. 77 ± 17 ml, p = 0.006); longer ERP (at 600 ms: 255 ± 25 ms vs. 222 ± 16 ms, p < 0.001; at 450 ms: 234 ± 20 ms vs. 212 ± 14 ms, p = 0.004); longer conduction time along linear catheters (57 ± 18 ms vs. 47 ± 10 ms, p = 0.01); longer bi-atrial activation time (128 ± 17 ms vs. 89 ± 10 ms, p < 0.001); slower conduction velocity (RA: 1.3 ± 0.3 mm/ms vs. 2.1 ± 0.5 mm/ms; LA: 1.2 ± 0.2 mm/ms vs. 2.2 ± 0.4 mm/ms, p < 0.001); greater proportion of fractionated electrograms (27 ± 8% vs. 8 ± 5%, p < 0.001); longer corrected sinus node recovery time (265 ± 57 ms vs. 185 ± 60 ms, p = 0.002); and lower voltage (RA: 1.7 ± 0.4 mV vs. 2.9 ± 0.4 mV; LA: 1.7 ± 0.7 mV vs. 3.3 ± 0.7 mV, p < 0.001). Conclusions: Patients with paroxysmal lone AF, remote from arrhythmia, demonstrate bi-atrial abnormalities characterized by structural change, conduction abnormalities, and sinus node dysfunction. These factors are likely contributors to the "second factor" that predisposes to the development and progression of AF.

LanguageEnglish
Pages1182-1191
Number of pages10
JournalJournal of the American College of Cardiology
Volume53
Issue number14
DOIs
Publication statusPublished - 7 Apr 2009

Keywords

  • arrhythmia
  • atrial fibrillation
  • atrial remodeling
  • atrial substrate
  • electrophysiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stiles, Martin K. ; John, Bobby ; Wong, Christopher X. ; Kuklik, Pawel ; Brooks, Anthony G. ; Lau, Dennis H. ; Dimitri, Hany ; Roberts-Thomson, Kurt C. ; Wilson, Lauren ; De Sciscio, Paolo ; Young, Glenn D. ; Sanders, Prashanthan. / Paroxysmal Lone Atrial Fibrillation Is Associated With an Abnormal Atrial Substrate. Characterizing the "Second Factor". In: Journal of the American College of Cardiology. 2009 ; Vol. 53, No. 14. pp. 1182-1191.
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title = "Paroxysmal Lone Atrial Fibrillation Is Associated With an Abnormal Atrial Substrate. Characterizing the {"}Second Factor{"}",
abstract = "Objectives: The purpose of this study was to determine whether patients with paroxysmal {"}lone{"} atrial fibrillation (AF) have an abnormal atrial substrate. Background: While {"}AF begets AF,{"} prompt termination to prevent electrical remodeling does not prevent disease progression. Methods: Twenty-five patients with paroxysmal lone AF, without arrhythmia in the week prior, and 25 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium (RA), crista terminalis, coronary sinus, septal RA, and sequentially within the left atrium (LA) determined the effective refractory period (ERP) at 10 sites, conduction time along linear catheters, and conduction characteristics at the crista terminalis. Bi-atrial electroanatomic maps were created to determine regional differences in conduction velocity and voltage. Results: Patients with AF demonstrated the following compared with reference patients: larger atrial volumes (RA: 94 ± 18 ml vs. 69 ± 9 ml, p = 0.003; LA: 99 ± 19 ml vs. 77 ± 17 ml, p = 0.006); longer ERP (at 600 ms: 255 ± 25 ms vs. 222 ± 16 ms, p < 0.001; at 450 ms: 234 ± 20 ms vs. 212 ± 14 ms, p = 0.004); longer conduction time along linear catheters (57 ± 18 ms vs. 47 ± 10 ms, p = 0.01); longer bi-atrial activation time (128 ± 17 ms vs. 89 ± 10 ms, p < 0.001); slower conduction velocity (RA: 1.3 ± 0.3 mm/ms vs. 2.1 ± 0.5 mm/ms; LA: 1.2 ± 0.2 mm/ms vs. 2.2 ± 0.4 mm/ms, p < 0.001); greater proportion of fractionated electrograms (27 ± 8{\%} vs. 8 ± 5{\%}, p < 0.001); longer corrected sinus node recovery time (265 ± 57 ms vs. 185 ± 60 ms, p = 0.002); and lower voltage (RA: 1.7 ± 0.4 mV vs. 2.9 ± 0.4 mV; LA: 1.7 ± 0.7 mV vs. 3.3 ± 0.7 mV, p < 0.001). Conclusions: Patients with paroxysmal lone AF, remote from arrhythmia, demonstrate bi-atrial abnormalities characterized by structural change, conduction abnormalities, and sinus node dysfunction. These factors are likely contributors to the {"}second factor{"} that predisposes to the development and progression of AF.",
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author = "Stiles, {Martin K.} and Bobby John and Wong, {Christopher X.} and Pawel Kuklik and Brooks, {Anthony G.} and Lau, {Dennis H.} and Hany Dimitri and Roberts-Thomson, {Kurt C.} and Lauren Wilson and {De Sciscio}, Paolo and Young, {Glenn D.} and Prashanthan Sanders",
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Stiles, MK, John, B, Wong, CX, Kuklik, P, Brooks, AG, Lau, DH, Dimitri, H, Roberts-Thomson, KC, Wilson, L, De Sciscio, P, Young, GD & Sanders, P 2009, 'Paroxysmal Lone Atrial Fibrillation Is Associated With an Abnormal Atrial Substrate. Characterizing the "Second Factor"', Journal of the American College of Cardiology, vol. 53, no. 14, pp. 1182-1191. https://doi.org/10.1016/j.jacc.2008.11.054

Paroxysmal Lone Atrial Fibrillation Is Associated With an Abnormal Atrial Substrate. Characterizing the "Second Factor". / Stiles, Martin K.; John, Bobby; Wong, Christopher X.; Kuklik, Pawel; Brooks, Anthony G.; Lau, Dennis H.; Dimitri, Hany; Roberts-Thomson, Kurt C.; Wilson, Lauren; De Sciscio, Paolo; Young, Glenn D.; Sanders, Prashanthan.

In: Journal of the American College of Cardiology, Vol. 53, No. 14, 07.04.2009, p. 1182-1191.

Research output: Contribution to journalArticle

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AU - Stiles, Martin K.

AU - John, Bobby

AU - Wong, Christopher X.

AU - Kuklik, Pawel

AU - Brooks, Anthony G.

AU - Lau, Dennis H.

AU - Dimitri, Hany

AU - Roberts-Thomson, Kurt C.

AU - Wilson, Lauren

AU - De Sciscio, Paolo

AU - Young, Glenn D.

AU - Sanders, Prashanthan

PY - 2009/4/7

Y1 - 2009/4/7

N2 - Objectives: The purpose of this study was to determine whether patients with paroxysmal "lone" atrial fibrillation (AF) have an abnormal atrial substrate. Background: While "AF begets AF," prompt termination to prevent electrical remodeling does not prevent disease progression. Methods: Twenty-five patients with paroxysmal lone AF, without arrhythmia in the week prior, and 25 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium (RA), crista terminalis, coronary sinus, septal RA, and sequentially within the left atrium (LA) determined the effective refractory period (ERP) at 10 sites, conduction time along linear catheters, and conduction characteristics at the crista terminalis. Bi-atrial electroanatomic maps were created to determine regional differences in conduction velocity and voltage. Results: Patients with AF demonstrated the following compared with reference patients: larger atrial volumes (RA: 94 ± 18 ml vs. 69 ± 9 ml, p = 0.003; LA: 99 ± 19 ml vs. 77 ± 17 ml, p = 0.006); longer ERP (at 600 ms: 255 ± 25 ms vs. 222 ± 16 ms, p < 0.001; at 450 ms: 234 ± 20 ms vs. 212 ± 14 ms, p = 0.004); longer conduction time along linear catheters (57 ± 18 ms vs. 47 ± 10 ms, p = 0.01); longer bi-atrial activation time (128 ± 17 ms vs. 89 ± 10 ms, p < 0.001); slower conduction velocity (RA: 1.3 ± 0.3 mm/ms vs. 2.1 ± 0.5 mm/ms; LA: 1.2 ± 0.2 mm/ms vs. 2.2 ± 0.4 mm/ms, p < 0.001); greater proportion of fractionated electrograms (27 ± 8% vs. 8 ± 5%, p < 0.001); longer corrected sinus node recovery time (265 ± 57 ms vs. 185 ± 60 ms, p = 0.002); and lower voltage (RA: 1.7 ± 0.4 mV vs. 2.9 ± 0.4 mV; LA: 1.7 ± 0.7 mV vs. 3.3 ± 0.7 mV, p < 0.001). Conclusions: Patients with paroxysmal lone AF, remote from arrhythmia, demonstrate bi-atrial abnormalities characterized by structural change, conduction abnormalities, and sinus node dysfunction. These factors are likely contributors to the "second factor" that predisposes to the development and progression of AF.

AB - Objectives: The purpose of this study was to determine whether patients with paroxysmal "lone" atrial fibrillation (AF) have an abnormal atrial substrate. Background: While "AF begets AF," prompt termination to prevent electrical remodeling does not prevent disease progression. Methods: Twenty-five patients with paroxysmal lone AF, without arrhythmia in the week prior, and 25 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium (RA), crista terminalis, coronary sinus, septal RA, and sequentially within the left atrium (LA) determined the effective refractory period (ERP) at 10 sites, conduction time along linear catheters, and conduction characteristics at the crista terminalis. Bi-atrial electroanatomic maps were created to determine regional differences in conduction velocity and voltage. Results: Patients with AF demonstrated the following compared with reference patients: larger atrial volumes (RA: 94 ± 18 ml vs. 69 ± 9 ml, p = 0.003; LA: 99 ± 19 ml vs. 77 ± 17 ml, p = 0.006); longer ERP (at 600 ms: 255 ± 25 ms vs. 222 ± 16 ms, p < 0.001; at 450 ms: 234 ± 20 ms vs. 212 ± 14 ms, p = 0.004); longer conduction time along linear catheters (57 ± 18 ms vs. 47 ± 10 ms, p = 0.01); longer bi-atrial activation time (128 ± 17 ms vs. 89 ± 10 ms, p < 0.001); slower conduction velocity (RA: 1.3 ± 0.3 mm/ms vs. 2.1 ± 0.5 mm/ms; LA: 1.2 ± 0.2 mm/ms vs. 2.2 ± 0.4 mm/ms, p < 0.001); greater proportion of fractionated electrograms (27 ± 8% vs. 8 ± 5%, p < 0.001); longer corrected sinus node recovery time (265 ± 57 ms vs. 185 ± 60 ms, p = 0.002); and lower voltage (RA: 1.7 ± 0.4 mV vs. 2.9 ± 0.4 mV; LA: 1.7 ± 0.7 mV vs. 3.3 ± 0.7 mV, p < 0.001). Conclusions: Patients with paroxysmal lone AF, remote from arrhythmia, demonstrate bi-atrial abnormalities characterized by structural change, conduction abnormalities, and sinus node dysfunction. These factors are likely contributors to the "second factor" that predisposes to the development and progression of AF.

KW - arrhythmia

KW - atrial fibrillation

KW - atrial remodeling

KW - atrial substrate

KW - electrophysiology

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