Published Online
on August 4, 2003

A more recent version of this article appeared on August 12, 2003

This Article Full Text (PDF) All Versions of this Article: 108/6/668    most recent 01.CIR.0000086979.39843.7Bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kalifa, J. Articles by Nattel, S. Search for Related Content PubMed PubMed Citation Articles by Kalifa, J. Articles by Nattel, S. Pubmed/NCBI databases Medline Plus Health Information Atrial Fibrillation Related Collections Animal models of human disease Arrythmias-basic studies Arrhythmias, clinical electrophysiology, drugs

Submitted on April 17, 2003
Revised on June 6, 2003
Accepted on June 6, 2003

Intra-Atrial Pressure Increases Rate and Organization of Waves Emanating From the Superior Pulmonary Veins During Atrial Fibrillation

Jérôme Kalifa MD, José Jalife MD^*, Alexey V. Zaitsev PhD, Suveer Bagwe MD, Mark Warren PhD, Javier Moreno MD, Omer Berenfeld PhD, and Stanley Nattel MD

From the Institute for Cardiovascular Research and Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY (J.K., J.J., A.V.Z., S.B., M.W., J.M., O.B.), and the Research Center, Montreal Heart Institute and University of Montreal, Quebec, Canada (J.K., S.N.).

^* To whom correspondence should be addressed. E-mail: jalifej{at}upstate.edu.

Background--Atrial fibrillation (AF) commonly associates with atrial dilatation by poorly understood mechanisms. We hypothesized that elevation of intra-atrial pressure elicits high-frequency and spatio-temporally organized left atrial (LA) sources emanating from the superior pulmonary veins.

Methods and Results--We used a stretch-related AF model in the sheep heart to induce stable episodes of AF (>40 minutes) in 9 animals. Video movies of the LA free wall (LAFW) and LA superior pulmonary vein junction (JPV) were obtained by using di-4-ANEPPS. Electrograms from the right atrium were recorded. At intra-atrial pressures >10 cm H₂O, the maximum dominant frequency (DF_Max) was significantly higher in the JPV than in the LAFW (12.0±0.2 and 10.5±0.2 Hz, respectively [mean±SEM]; P<0.001). Below 10 cm H₂O, DF_Max was similar in the JPV and LAFW (10.8±0.3 versus 10.2±0.3 Hz; P=0.6); DF_Max in both JPV and LAFW was significantly higher than in the right atrium (7.8±0.3 Hz; P<0.001). Analysis of excitation direction in JPV showed positive correlation between intra-atrial pressure and the number of waves emanating from the left superior pulmonary vein (r=0.79, P=0.02) but not from the LAFW (r=0.54, P=0.09). The number of spatio-temporally periodic waves in the JPV correlated with pressure (r=0.92, P=0.002). In 3 cases, JPV rotors were identified with a cycle length equal to 1/DF_Max.

Conclusion--We demonstrate for the first time that an increase in intra-atrial pressure increases the rate and organization of waves emanating from the superior pulmonary veins underlying stretch-related AF.

Key words: arrhythmia • fibrillation • atrial • waves • pressure • intra-atrial • veins • pulmonary

This article has been cited by other articles:

				K. Nishida, G. Michael, D. Dobrev, and S. Nattel Animal models for atrial fibrillation: clinical insights and scientific opportunities Europace, October 29, 2009; (2009) eup328v1. [Abstract] [Full Text] [PDF]

				J. Qi, J. Xiao, Y. Zhang, J. Li, Y. Liu, P. Li, L. Liang, B. Jiang, W. Wen, C. Zhao, et al. Effects of Potassium Channel Blockers on Changes in Refractoriness of Atrial Cardiomyocytes Induced by Stretch Experimental Biology and Medicine, July 1, 2009; 234(7): 779 - 784. [Abstract] [Full Text] [PDF]

				E. J. Benjamin, P.-S. Chen, D. E. Bild, A. M. Mascette, C. M. Albert, A. Alonso, H. Calkins, S. J. Connolly, A. B. Curtis, D. Darbar, et al. Prevention of Atrial Fibrillation: Report From a National Heart, Lung, and Blood Institute Workshop Circulation, February 3, 2009; 119(4): 606 - 618. [Abstract] [Full Text] [PDF]

				T. Arentz, R. Weber, G. Burkle, C. Herrera, T. Blum, J. Stockinger, J. Minners, F. J. Neumann, and D. Kalusche Small or Large Isolation Areas Around the Pulmonary Veins for the Treatment of Atrial Fibrillation?: Results From a Prospective Randomized Study Circulation, June 19, 2007; 115(24): 3057 - 3063. [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]

				M. Osranek, K. Fatema, F. Qaddoura, A. Al-Saileek, M. E. Barnes, K. R. Bailey, B. J. Gersh, T. S.M. Tsang, K. J. Zehr, and J. B. Seward Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery: A Prospective Study J. Am. Coll. Cardiol., August 15, 2006; 48(4): 779 - 786. [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]

				H.-R. Neuberger, U. Schotten, Y. Blaauw, D. Vollmann, S. Eijsbouts, A. van Hunnik, and M. Allessie Chronic Atrial Dilation, Electrical Remodeling, and Atrial Fibrillation in the Goat J. Am. Coll. Cardiol., February 7, 2006; 47(3): 644 - 653. [Abstract] [Full Text] [PDF]

				J. Kalifa, K. Tanaka, A. V. Zaitsev, M. Warren, R. Vaidyanathan, D. Auerbach, S. Pandit, K. L. Vikstrom, R. Ploutz-Snyder, A. Talkachou, et al. Mechanisms of Wave Fractionation at Boundaries of High-Frequency Excitation in the Posterior Left Atrium of the Isolated Sheep Heart During Atrial Fibrillation Circulation, February 7, 2006; 113(5): 626 - 633. [Abstract] [Full Text] [PDF]

				W. P. Beukema, A. Elvan, H. T. Sie, A. R. Ramdat Misier, and H. J.J. Wellens Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size Circulation, October 4, 2005; 112(14): 2089 - 2095. [Abstract] [Full Text] [PDF]

				Y.-J. Lin, C.-T. Tai, T. Kao, H.-W. Tso, J.-L. Huang, S. Higa, Y. Yuniadi, B.-H. Huang, T.-Y. Liu, P.-C. Lee, et al. Electrophysiological Characteristics and Catheter Ablation in Patients With Paroxysmal Right Atrial Fibrillation Circulation, September 20, 2005; 112(12): 1692 - 1700. [Abstract] [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]

				J. S. Healey, A. Baranchuk, E. Crystal, C. A. Morillo, M. Garfinkle, S. Yusuf, and S. J. Connolly Prevention of Atrial Fibrillation With Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: A Meta-Analysis J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1832 - 1839. [Abstract] [Full Text] [PDF]

				S. S. Po, Y. Li, D. Tang, H. Liu, N. Geng, W. M. Jackman, B. Scherlag, R. Lazzara, and E. Patterson Rapid and Stable Re-Entry Within the Pulmonary Vein as a Mechanism Initiating Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1871 - 1877. [Abstract] [Full Text] [PDF]

				A. Verma, O. M. Wazni, N. F. Marrouche, D. O. Martin, F. Kilicaslan, S. Minor, R. A. Schweikert, W. Saliba, J. Cummings, J. D. Burkhardt, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: An independent predictor of procedural failure J. Am. Coll. Cardiol., January 18, 2005; 45(2): 285 - 292. [Abstract] [Full Text] [PDF]

				R. Khan Identifying and understanding the role of pulmonary vein activity in atrial fibrillation Cardiovasc Res, December 1, 2004; 64(3): 387 - 394. [Abstract] [Full Text] [PDF]

				S. Lazar, S. Dixit, F. E. Marchlinski, D. J. Callans, and E. P. Gerstenfeld Presence of Left-to-Right Atrial Frequency Gradient in Paroxysmal but Not Persistent Atrial Fibrillation in Humans Circulation, November 16, 2004; 110(20): 3181 - 3186. [Abstract] [Full Text] [PDF]

				G. D. Veenhuyzen, C. S. Simpson, and H. Abdollah Atrial fibrillation Can. Med. Assoc. J., September 28, 2004; 171(7): 755 - 760. [Abstract] [Full Text] [PDF]

				C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]