title: Simultaneous biatrial computerized mapping during permanent atrial fibrillation in patients with organic heart disease.
abstract: BACKGROUND
  Activation patterns during permanent atrial fibrillation (AF) in patients with organic heart diseases are unclear.
  
  
  RESULTS
  We studied six patients with permanent AF and organic heart diseases undergoing surgery. The duration of AF averaged 4.9+/-7.6 years. Computerized epicardial mappings of the right atrial (RA) free wall and the left atrial (LA) posterior wall were simultaneously performed with 224 bipolar electrodes at 3-mm spatial resolution. In the RA, large wavefronts and conduction blocks were frequently observed. The lines of block correlated with the crista terminalis and large pectinate muscles. In contrast, the LA had rapid repetitive activities originated from corners of the electrode plaque, near the four pulmonary veins (PVs). On average, 2.8+/-1.2 sites of rapid repetitive activities were identified per patient. They activated continuously, intermittently, or alternately during AF. The mean activation cycle length in the RA (196+/-22 msec) was significantly longer than that in the LA (179+/-26 msec; P = 0.004). The maximum dominant frequency in the LA was higher than that in the RA (6.41+/-1.18 Hz vs 5.66+/-0.55 Hz; P = 0.049). The maximum dominant frequency was consistently located in areas with rapid repetitive activations near the PVs.
  
  
  CONCLUSIONS
  During human permanent AF associated with organic heart diseases, the activation cycle length was shorter in the LA posterior wall than in the RA free wall. Rapid repetitive activities are consistently observed in the LA posterior wall, at or near the PVs.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, CA 90048, USA.
authors.forename: Tsu-Juey
authors.initials: TJ
authors.lastname: Wu
authors.forename: Rahul N
authors.initials: RN
authors.lastname: Doshi
authors.forename: Hsun-Lun A
authors.initials: HL
authors.lastname: Huang
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanche
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kass
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Hrayr S
authors.initials: HS
authors.lastname: Karagueuzian
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Peter
authors.forename: Peng-Sheng
authors.initials: PS
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery; D018780:Body Surface Potential Mapping; D002908:Chronic Disease; D004554:Electric Countershock; D004567:Electrodes, Implanted; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D013997:Time Factors