title: Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation.
abstract: Pulmonary veins are considered to be the most common origin of the focal activity that triggers the onset of atrial fibrillation (AF). However, little is known about the importance of ectopic activity located outside the pulmonary veins. This study included 45 patients (8 women and 37 men, mean age 55 +/- 12 years) with paroxysmal (n = 25) and persistent (n = 20) AF in whom multisite mapping of the right and left atria was performed using a 64-electrode basket catheter (n = 21) or a noncontact mapping system (n = 24). Spontaneous or orciprenaline-induced atrial premature complexes (APCs) were mapped. In all, 94 AF onsets from 38 distinct foci in 30 patients were observed and analyzed. Of these foci, 20 (53%) were located in pulmonary veins and 18 (47%) were located outside the pulmonary veins in other parts of the atria. In 22 patients (73%), AF was reproducibly induced by APCs from a single focus (59 episodes). In 8 patients (27%), AF originated from 2 distinct foci (35 episodes). Additionally, 20 of 30 patients (67%) who developed AF had APCs in different locations not inducing AF. APCs inducing AF had shorter coupling intervals than APCs not inducing AF (307 +/- 54 vs 409 +/- 76 ms, p <0.001). This study showed that 47% of ectopic foci triggering the onset of AF were located outside the pulmonary veins in extravenous parts of the left atrium and the right atrium, and 27% of patients had AF onsets of bifocal origin. These data challenge the current opinion that extrapulmonary foci play a minor role in inducing AF.
authors.affiliation: Deutsches Herzzentrum München and 1 Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. schmitt@dhm.mhn.de
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schmieder
authors.forename: Sonja
authors.initials: S
authors.lastname: Weyerbrock
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.forename: Martin R
authors.initials: MR
authors.lastname: Karch
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schreieck
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D018880:Atrial Premature Complexes / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000379:methods; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D016896:Treatment Outcome