title: Reentrant and focal activations during atrial fibrillation in patients with atrial septal defect.
abstract: BACKGROUND
  Adult patients with atrial septal defect frequently experience atrial fibrillation. However, the electrophysiologic mechanism has not been directly examined, and the optimal surgical procedure has not been determined.
  
  
  METHODS
  Ten patients undergoing operations for atrial septal defect and atrial fibrillation underwent intraoperative mapping by use of 253 epicardial electrodes. There were 7 men and 3 women, whose average age was 54 ± 11 years. Eight patients had a secundum defect and 2 a primum defect. There were 4 patients with paroxysmal atrial fibrillation and 6 with long-standing persistent atrial fibrillation. A modified biatrial Maze procedure was performed in 6 patients and pulmonary vein isolation with no other left atrial lesions in 4.
  
  
  RESULTS
  The reentrant or focal activations driving atrial fibrillation were confined within the right atrium in all patients with paroxysmal atrial fibrillation, whereas multiple focal activations arising from the pulmonary veins or posterior left atrium and reentrant activations in the left atrium were observed in 5 of 6 patients with long-standing persistent atrial fibrillation. In 9 patients, sinus rhythm was restored postoperatively and 8 of those patients have been free of any atrial fibrillation during a follow-up period of 94 ± 45 months.
  
  
  CONCLUSIONS
  The pattern of the atrial activation during atrial fibrillation correlated with the type of atrial fibrillation and varied from a simple right atrial reentry to complex reentrant and focal activations in the left atrium.
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: nitta@nms.ac.jp.
authors: Takashi
authors: T
authors: Nitta
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors: Shun-Ichiro
authors: SI
authors: Sakamoto
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors: Yasuo
authors: Y
authors: Miyagi
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Fujii
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors: Yosuke
authors: Y
authors: Ishii
authors: Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
authors: Masami
authors: M
authors: Ochi
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged
keywords: 24