Electrical atrial remodeling assessed by monophasic action potential and atrial refractoriness in patients with structural heart disease.
The present study was performed to assess the effect of induced atrial fibrillation (AF) on atrial monophasic action potentials (MAPs) and atrial refractory period (ERP) in patients with structural heart disease. An electrode MAP catheter was placed in the right atrium to continuously measure atrial potential duration (APD90) in 13 patients (coronary artery disease, 10 patients; dilated cardiomyopathy, 2 patients; hypertrophic cardiomyopathy, 1 patient) without spontaneous AF episodes. AF was induced by rapid atrial stimulation (300-1500/min). If sinus rhythm returned within 10 minutes, AF was reinduced. The atrial ERP was measured during atrial pacing at a basic cycle length of 550 ms before AF induction and after its conversion.


RESULTS
The mean atrial ERP and the atrial APD90 before AF was 242 +/- 34 ms and 256 +/- 23 ms, respectively. ERP and APD90 shortening was observed after 3 minutes of AF. After 11 +/- 0.5 min (10 min 20 s-13 min 10 s) of AF, ERP and APD90 reached their minimal values of 72% +/- 13% and 71% +/- 10% of baseline, respectively. ERP and APD90 returned to their initial values within 10 minutes after conversion of AF. A tendency toward longer duration of consecutive AF episodes and facilitation of their induction was observed.


CONCLUSIONS
The present study confirms that short episodes of AF modify the electrophysiological properties of the atria in humans. In patients with structural heart disease, induced atrial fibrillation shortens the atrial ERP as well as the atrial APD90. The changes were reversible within 10 minutes after arrhythmia termination.
Lubinski
A
A
II Department of Cardiology, Medical University, Gdansk, Poland.
Kempa
M
M
Lewicka-Nowak
E
E
Królak
T
T
Raczak
G
G
Swiatecka
G
G
D000200:Action Potentials / Q000502:physiology; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D016280:Atrial Function, Right / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged