title: Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans.
abstract: BACKGROUND
  Atrial fibrillation (AF) frequently complicates congestive heart failure (CHF). However, the electrophysiological substrate for AF in humans with CHF remains unknown. We evaluated the electrophysiological and electroanatomic characteristics of the atria in patients with CHF.
  
  
  RESULTS
  Twenty-one patients (aged 53.7+/-13.6 years) with symptomatic CHF (left ventricular ejection fraction 25.5+/-6.0%) and 21 age-matched controls were studied. The following were evaluated: effective refractory periods (ERPs) from the high and low lateral right atrium (LRA), high septal right atrium, and distal coronary sinus (CS); conduction time along the CS and LRA; corrected sinus node recovery times; P-wave duration; and conduction at the crista terminalis. In a subset, electroanatomic mapping was performed to determine atrial activation, regional conduction velocity, double potentials, fractionated electrograms, regional voltage, and areas of electrical silence. Patients with CHF demonstrated an increase in atrial ERP with no change in the heterogeneity of refractoriness, an increase of atrial conduction time along the LRA and the CS, prolongation of the P-wave duration and corrected sinus node recovery times, and greater number and duration of double potentials along the crista terminalis. Electroanatomic mapping demonstrated regional conduction slowing with a greater number of electrograms with fractionation or double potentials, associated with areas of low voltage and electrical silence (scar). Patients with CHF demonstrated an increased propensity for AF with single extrastimuli, and induced AF was more often sustained.
  
  
  CONCLUSIONS
  Atrial remodeling due to CHF is characterized by structural changes, abnormalities of conduction, sinus node dysfunction, and increased refractoriness. These abnormalities may be responsible in part for the increased propensity for AF in CHF.
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.forename: Neil C
authors.initials: NC
authors.lastname: Davidson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Spence
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Vohra
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
mesh_terms: D016275:Atrial Function; D018780:Body Surface Potential Mapping; D004562:Electrocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D012849:Sinoatrial Node / Q000503:physiopathology; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors