Article

Functional characterization of atrial electrograms in sinus rhythm delineates sites of parasympathetic innervation in patients with paroxysmal atrial fibrillation.

UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
Journal of the American College of Cardiology (impact factor: 14.16). 11/2007; 50(14):1324-31. DOI:10.1016/j.jacc.2007.03.069 pp.1324-31
Source: PubMed

ABSTRACT This study sought to characterize left atrial (LA) sinus rhythm electrogram (EGM) patterns and their relationship to parasympathetic responses during atrial fibrillation (AF) ablation.
The mechanistic basis of fractionated LA EGMs in patients with paroxysmal AF is not well understood.
We analyzed 1,662 LA ablation sites from 30 patients who underwent catheter ablation for paroxysmal AF. Pre-ablation EGM characteristics (number of deflections, amplitude, and duration) were measured in sinus rhythm. Parasympathetic responses during radiofrequency application (increase of atrial-His interval by > or =10 ms or decrease of sinus rate by > or =20%) were assessed at all sites. We also prospectively studied the effect of adenosine, a pharmacological agent mimicking acetylcholine signaling in myocytes, on LA EGMs. Finally, we performed mathematical simulations of atrial tissue to delineate possible mechanisms of fractionated EGMs in sinus rhythm.
A specific pattern of pre-ablation sinus rhythm EGM (deflections > or =4, amplitude > or =0.7 mV, and duration > or =40 ms) was strongly associated with parasympathetic responses (sensitivity 72%, specificity 91%). The sites associated with these responses were found to be located mainly in the posterior wall of the LA. Adenosine administration and mathematical simulation of the effect of acetylcholine were able to reproduce a similar EGM pattern.
Parasympathetic activation during AF ablation is associated with the presence of pre-ablation high-amplitude fractionated EGMs in sinus rhythm. Local acetylcholine release could potentially explain this phenomenon.

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Keywords

30 patients
 
Adenosine administration
 
AF ablation
 
atrial fibrillation
 
atrial tissue
 
atrial-His interval
 
catheter ablation
 
delineate possible mechanisms
 
fractionated EGMs
 
fractionated LA EGMs
 
LA EGMs
 
Local acetylcholine release
 
mathematical simulation
 
mathematical simulations
 
paroxysmal AF
 
posterior wall
 
Pre-ablation EGM characteristics
 
pre-ablation high-amplitude fractionated EGMs
 
pre-ablation sinus rhythm EGM
 
similar EGM pattern