title: Characterization of atrial activation (A-A) intervals during atrial fibrillation due to a single driver: do they reflect atrial effective refractory periods?
abstract: BACKGROUND
  The mean, median, and minimum local atrial activation (A-A) intervals have been used to determine the local atrial effective refractory period (AERP) during atrial fibrillation (AF), the underlying assumption being that AF is due to multiple reentrant wavelets.
  
  
  OBJECTIVE
  We tested the hypothesis that when AF is due to a single, rapid, stable reentrant circuit (driver), the minimum and mean local A-A intervals will be similar at sites in the reentrant circuit, but will vary widely at sites with fibrillatory conduction, making these latter intervals unreliable indicators of AERP.
  
  
  METHODS
  During sustained AF due to a left atrial (LA) driver in 6 sterile pericarditis dogs, electrograms were recorded from 186 bipolar electrodes from both atria. A-A intervals were measured from each recording site during 1.2 seconds of AF. Minimum A-A intervals as well as temporal (within site) and spatial (between sites) variability were determined from all sites.
  
  
  RESULTS
  A-A intervals from each site during AF demonstrated that (1) 90-100% of right atrial (RA) sites and 18-39% of LA sites showed considerable (SD > 6 ms) temporal variability; (2) RA and LA sites with fibrillatory conduction (SD > 6 ms) showed considerable (a) spatial variability (RA: 9-36 ms; LA: 5-27 ms) and (b) variability of the minimum A-A intervals (RA: 14-35 ms; LA 11-28 ms).
  
  
  CONCLUSIONS
  During AF due to a driver, areas with fibrillatory conduction manifested considerable variability in the mean and the minimum A-A intervals. Therefore, it is unlikely that any of the A-A intervals reflect AERP.
authors.affiliation: Department of Medicine, Division of Cardiology, Case Western Reserve University/University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jayakumar.sahadevan@va.gov
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Sahadevan
authors.forename: Kyungmoo
authors.initials: K
authors.lastname: Ryu
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Celeen M
authors.initials: CM
authors.lastname: Khrestian
authors.forename: Albert L
authors.initials: AL
authors.lastname: Waldo
mesh_terms: D000200:Action Potentials; D000818:Animals; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D016275:Atrial Function; D004195:Disease Models, Animal; D004285:Dogs; D022062:Electrophysiologic Techniques, Cardiac; D006325:Heart Atria / Q000503:physiopathology; D012032:Refractory Period, Electrophysiological; D013997:Time Factors