title: The early stage of the atrial electroanatomic remodeling as substrates for atrial fibrillation in hypertensive patients.
abstract: BACKGROUND
  Hypertension is one of the most important risk factors for atrial fibrillation (AF). Recent studies suggest right atrial remodeling in hypertensive patients may be associated with increased inducibility of AF. This study sought to characterize the electroanatomic features of left and right atria and pulmonary veins (PVs) in hypertensive patients.
  
  
  RESULTS
  A prospective observational study was conducted on patients who underwent ablation for paroxysmal supraventricular tachycardia or paroxysmal AF. Electrophysiological features of the PVs and atria, including event-related potentials, conduction time, and inducibility and vulnerability of AF, were characterized during cardiac catheterization. Anatomic and hemodynamic features were assessed by using echocardiographic and computer tomography imaging. When 15 hypertensive patients with paroxysmal supraventricular tachycardia were compared with 17 normotensive patients with paroxysmal supraventricular tachycardia, the hypertensive patients had significantly shortened PV event-related potentials with increased dispersions (P<0.001) but slightly prolonged atrial event-related potentials (P=NS) and had prolonged interatrial and intra-atrial conduction times (P<0.001). Additionally, the hypertensive patients had increased vulnerability and inducibility of AF and prolonged duration of induced AF (P<0.01). All of these changes were more pronounced in hypertensive patients with paroxysmal AF. Anatomically, compared with the normotensive patients, the diameters of 4 PVs in the hypertensive patients with paroxysmal supraventricular tachycardia were significantly enlarged (P<0.01) and became more remarkable in hypertensive patients with paroxysmal AF (P<0.0001), although the diameter and volume index of the left atrium among 3 groups were similar.
  
  
  CONCLUSIONS
  The hypertensive patients showed electroanatomic changes associated with increased vulnerability to AF, including shortened event-related potentials with increased dispersion, prolonged conduction time, and increased PV diameter, but these changes were not appreciated in the atria. Additionally, these changes became more dramatic in hypertensive patients with paroxysmal AF.
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.) Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.).
authors.forename: Xiaomeng
authors.initials: X
authors.lastname: Yin
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.) Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX (Y.X., J.C.).
authors.forename: Yutao
authors.initials: Y
authors.lastname: Xi
authors.affiliation: Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.).
authors.forename: Nancy
authors.initials: N
authors.lastname: Cheng
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Yunlong
authors.initials: Y
authors.lastname: Xia
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Shulong
authors.initials: S
authors.lastname: Zhang
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Yingxue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Dong
authors.initials: D
authors.lastname: Chang
authors.affiliation: Texas Heart Institute/St Luke's Hospital, Houston, TX (X.Y., Y.X., N.C., J.C.) Section of Cardiology, University of Texas School of Medicine at Houston, Houston, TX (Y.X., J.C.).
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Yanzong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (X.Y., Y.Z., Y.X., S.Z., Y.D., D.C., Y.Y., L.G.).
authors.forename: Lianjun
authors.initials: L
authors.lastname: Gao
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D064752:Atrial Remodeling; D016022:Case-Control Studies; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D066253:Vascular Remodeling; D014664:Vasodilation
keywords: atrial fibrillation; atrium; hypertension; pulmonary veins; remodeling