title: Radiofrequency catheter ablation of the atria eliminates pacing-induced sustained atrial fibrillation and reduces connexin 43 in dogs.
abstract: BACKGROUND
  We assessed the effects of radiofrequency catheter ablation (RFCA) of the atrial epicardium on pacing-induced sustained atrial fibrillation (AF) and the expression and distribution of the intercellular gap junction protein connexin 43 (Cx43) in dogs.
  
  
  RESULTS
  In 12 mongrel dogs, after creation of complete AV block and implantation of a ventricular inhibited pacemaker, a high-rate pulse generator (20 to 30 Hz to induce AF) was implanted in the neck, connected to a right atrial endocardial pacing lead, and used to pace the atrium for 10 to 14 weeks. In group 1 (n=9 dogs), corrected sinus node recovery time (CSNRT), P-wave duration, 24-hour Holter ECG, maximal heart rate (MHR) in response to isoproterenol, and intrinsic heart rate (IHR) after atropine (0.04 mg/kg) and propranolol were measured before and after atrial pacing and RFCA. Group 2 dogs were used to assess the effect of chronic AF alone on Cx43 expression and distribution. All group 1 dogs developed sustained (>24 hours) AF. Right-sided RFCA of the atria eliminated the sustained AF in 5 dogs, but both right and left atrial RFCA was required to abolish sustained AF in the other 4 dogs. After RFCA restored sinus rhythm, CSNRT and P-wave duration were prolonged and MHR and IHR were decreased. Chronic rapid atrial pacing (group 2) increased the expression of Cx43, which was absent in ablated areas and markedly depressed in viable atrial myocytes near the ablation zones (group 1).
  
  
  CONCLUSIONS
  Rapid atrial pacing for long time periods induced sustained AF that can be eliminated by linear right and left atrial lesions created with RFCA, with preservation of sinus rhythm and atrial contractile function. Chronic AF increased the expression and distribution of gap junction protein Cx43, which became reduced in ablated and nearby nonablated areas.
authors.affiliation: Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-4800, USA.
authors.forename: A
authors.initials: A
authors.lastname: Elvan
authors.forename: X D
authors.initials: XD
authors.lastname: Huang
authors.forename: M L
authors.initials: ML
authors.lastname: Pressler
authors.forename: D P
authors.initials: DP
authors.lastname: Zipes
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D016275:Atrial Function; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation; D018031:Connexin 43 / Q000378:metabolism; D004285:Dogs; D004452:Echocardiography; D005260:Female; D006325:Heart Atria; D006329:Heart Conduction System / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D007150:Immunohistochemistry; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D012032:Refractory Period, Electrophysiological; D012849:Sinoatrial Node / Q000503:physiopathology
chemical_list: D018031:Connexin 43