title: Electrophysiological and Electroanatomical Mapping of the Right Atrium in Persistent Atrial Fibrillation: Relation to Collagen Turnover.
abstract: BACKGROUND
  Atrial fibrillation (AF) is associated with abnormal atrial substrate. We investigated whether patients with persistent lone AF and patients with persistent AF and nonischemic dilated cardiomyopathy (NIDCM) exhibit any differences in electrophysiological and electroanatomical properties of right atrium (RA) and collagen turnover. We also investigated the relationship between mean RA bipolar voltage and collagen turnover.
  
  
  METHODS
  Ten patients with a history of persistent lone AF and eight patients with a history of persistent AF and NIDCM were studied. Sinus node recovery times (SNRTs) and effective refractory periods (ERPs) at 600 ms, 500 ms, and 400 ms from the high (HLRA) and low (LLRA) lateral RA, proximal coronary sinus (pCS), and right atrial appendage (RAA) were evaluated, and RA electroanatomic mapping was created. Serum N-terminal propeptide of collagen type I (PINP), cross-linked C-terminal telopeptide of collagen type I (CTx), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of matrix metalloproteinases (TIMP-1) were measured as markers of collagen synthesis and degradation.
  
  
  RESULTS
  No differences were found in SNRTs, ERPs from the HLRA, LLRA at 600 ms, pCS and RAA, mean RA bipolar voltage, serum PINP, CTx, MMP-1, and TIMP-1 between the two groups. In persistent lone AF, serum levels of TIMP-1 were related with mean HLRA and HPRA bipolar voltage.
  
  
  CONCLUSIONS
  Persistent AF patients with or without NIDCM, demonstrate similar changes in electrophysiological and electroanatomical properties of the RA, as well as similar structural changes. Moreover, serum markers of collagen synthesis are correlated with bipolar voltage in specific regions of RA in persistent lone AF.
authors.affiliation: Department of Cardiology.
authors.forename: Christos A
authors.initials: CA
authors.lastname: Goudis
authors.affiliation: Department of Cardiology.
authors.forename: Eleftherios M
authors.initials: EM
authors.lastname: Kallergis
authors.affiliation: Department of Cardiology.
authors.forename: Emmanuel M
authors.initials: EM
authors.lastname: Kanoupakis
authors.affiliation: Department of Cardiology.
authors.forename: Hercules E
authors.initials: HE
authors.lastname: Mavrakis
authors.affiliation: Laboratory of Biochemistry, Heraklion University Hospital, Crete, Greece.
authors.forename: Niki E
authors.initials: NE
authors.lastname: Malliaraki
authors.affiliation: Department of Cardiology.
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D018780:Body Surface Potential Mapping / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D002908:Chronic Disease; D003094:Collagen / Q000378:metabolism*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate
chemical_list: D003094:Collagen
keywords: atrial fibrillation; atrial fibrosis; collagen turnover