Circulation. 2004;110:3181-3186
Published online before print November 8, 2004, doi: 10.1161/01.CIR.0000147279.91094.5E
Published online before print November 8, 2004, doi: 10.1161/01.CIR.0000147279.91094.5E
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:3181-3186.)
© 2004 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Presence of Left-to-Right Atrial Frequency Gradient in Paroxysmal but Not Persistent Atrial Fibrillation in Humans
From the Electrophysiology Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pa.
Correspondence to Edward P. Gerstenfeld, MD, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104. E-mail edward.gerstenfeld{at}uphs.upenn.edu
Received December 30, 2003; de novo received March 23, 2004; revision received May 17, 2004; accepted June 4, 2004.
Background— Recent studies have demonstrated spatiotemporal organization in atrial fibrillation (AF), with a left-to-right atrial frequency gradient during AF in isolated sheep hearts. We hypothesized that human AF would also manifest a left-to-right atrial frequency gradient.
Methods and Results— Thirty-one patients aged 56.7±10.5 years with a history of paroxysmal or persistent (>1 month) AF were included. Recordings were made at each pulmonary vein (PV) ostium and simultaneously from the coronary sinus (CS) and posterior right atrium (RA) during AF. Sequential fast Fourier transforms (FFTs) were performed. FFT profiles were analyzed to determine the dominant frequency (DF). There were 18 patients with paroxysmal AF and 13 with persistent AF. In the paroxysmal group, there was a significant left-to-right atrial DF gradient, with DF highest at the PV/left atrial (LA) junction, intermediate at the CS, and lowest in the RA (6.2±0.8, 5.5±0.7, and 5.1±0.6 Hz, respectively; P<0.001). There were no patients in whom DF was greater at the RA than the PV/LA junction. In the persistent group, there was no significant difference between DF recorded from the LA/PV junction, CS, and RA (6.1±0.7, 5.8±0.6, and 5.8±0.6 Hz, respectively; P=NS).
Conclusions— In humans with paroxysmal AF, DFs are highest at the PV/LA junction, intermediate in the CS, and slowest in the posterior RA. These findings agree with animal models that suggest that the posterior LA may play an important role in maintaining paroxysmal AF. The role of the posterior LA in persistent AF requires further study.
Key Words: Key Words: • atrium • fibrillation • Fourier analysis
This article has been cited by other articles:
 |
|
 |
|
  I. Diemberger, J. McCready, L. Nunn, and A. W.C. Chow Is atrial fibrillation with very short cycle length suitable for ablation? A case report Europace, July 14, 2008; (2008) eun189v1. [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]
|
|
|
|
|
|
N.-W. Hsu, Y.-J. Lin, C.-T. Tai, T. Kao, S.-L. Chang, W. Wongcharoen, L.-W. Lo, A. R. Udyavar, Y.-F. Hu, H.-W. Tso, et al. Frequency analysis of the fibrillatory activity from surface ECG lead V1 and intracardiac recordings: implications for mapping of AF Europace, April 1, 2008; 10(4): 438 - 443. [Abstract] [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]
|
|
|
|
|
|
A. L. Waldo and G. K. Feld Inter-Relationships of Atrial Fibrillation and Atrial Flutter: Mechanisms and Clinical Implications J. Am. Coll. Cardiol., February 26, 2008; 51(8): 779 - 786. [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]
|
|
|
|
|
|
B. D. Lindsay Is Pulmonary Vein Antrum Isolation a Critical Determinant of Recurrent Arrhythmias After Ablation of Atrial Fibrillation? J. Am. Coll. Cardiol., August 28, 2007; 50(9): 875 - 876. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Sanders, M. Hocini, P. Jais, F. Sacher, L.-F. Hsu, Y. Takahashi, M. Rotter, T. Rostock, C. J. Nalliah, J. Clementy, et al. Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome Eur. Heart J., August 1, 2007; 28(15): 1862 - 1871. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bollmann, D. Husser, M. Stridh, F. Holmqvist, A. Roijer, C. J. Meurling, L. Sornmo, and S. B. Olsson Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation Europace, August 1, 2007; 9(8): 621 - 626. [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]
|
|
|
|
 |
|
 F. Atienza, J. Almendral, J. Moreno, R. Vaidyanathan, A. Talkachou, J. Kalifa, A. Arenal, J. P. Villacastin, E. G. Torrecilla, A. Sanchez, et al. Activation of Inward Rectifier Potassium Channels Accelerates Atrial Fibrillation in Humans: Evidence for a Reentrant Mechanism Circulation, December 5, 2006; 114(23): 2434 - 2442. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H. Everett IV, E. E. Wilson, S. Verheule, J. M. Guerra, S. Foreman, and J. E. Olgin Structural atrial remodeling alters the substrate and spatiotemporal organization of atrial fibrillation: a comparison in canine models of structural and electrical atrial remodeling Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2911 - H2923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [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]
|
|
|
|
|
|
L. Calo, F. Lamberti, M. L. Loricchio, E. De Ruvo, F. Colivicchi, L. Bianconi, C. Pandozi, and M. Santini Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation: A Prospective and Randomized Study J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2504 - 2512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mansour Highest Dominant Frequencies in Atrial Fibrillation: A New Target for Ablation? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1408 - 1409. [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]
|
|
|
|
 |
|
 M. A. Wood and K. A. Ellenbogen Catheter ablation of chronic atrial fibrillation--the gap between promise and practice. N. Engl. J. Med., March 2, 2006; 354(9): 967 - 969. [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, O. Berenfeld, M. Hocini, P. Jais, R. Vaidyanathan, L.-F. Hsu, S. Garrigue, Y. Takahashi, M. Rotter, F. Sacher, et al. Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans Circulation, August 9, 2005; 112(6): 789 - 797. [Abstract] [Full Text] [PDF]
|
|