Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Epicardial right atrial free wall mapping in chronic atrial fibrillation
Documentation of repetitive activation with a focal spread—a hitherto unrecognised phenomenon in man
Department of Cardiology, University Hospital Lund, Sweden
*Department of cardiotlioracic Surgery, University Hospital Lund, Sweden
revised 10 June 1996; accepted 12 June 1996.
Correspondence: Magnus Holm, Department of Cardiology, University Hospital, S-221 85 Lund, Sweden
Abstract
BACKGROUND: Previous studies have shown that atrial fibrillation of recent onset in man is based on a varying number of simultaneously present activation waves re-entering either themselves or each other. In the present study, right atrial activation during chronic atrial fibrillation in man was studied.
METHODS AND RESULTS: In 16 patients with chronic atrial fibrillation multiple epicardial recordings of 8 s each were made at the right atrial posterior free wall and at the appendage using a 20x35 mm electrode array with 56 bipolar measurement points. The preferable activation pattern of each recording and the propagation direction, cycle length and conduction velocity of individual activation waves within each recording were determined. Activation was characterized by unorganised activation with several simultaneously present activation waves: inconsistent preferable activation pattern (n=5), predominantly organised activation with either frequent episodes of uniform activation; consistent preferable activation pattern (n=7) or frequent episodes of activation with focal spread; focal preferable activation pattern (n=4). Random re-entry was frequently documented in recordings with the inconsistent preferable activation pattern and less frequently in recordings with the consistent and focal preferable activation pattern. Complete re-entry circuits were rarely documented. The median fibrillation cycle length was 146, 159 (P<0·05) and 165 ms (not significant) and the mean conduction velocity during uniform activation was 64, 67 and 83 cm.s–1 (not significant) in recordings with the inconsistent, consistent and focal preferable activation pattern, respectively.
CONCLUSIONS: During chronic atrial fibrillation in man, right atrial free wall activation ranges from disorganised activation with multiple co-existing activation waves to predominantly organised activation characterized by either uniform activation consistent with the presence of large re-entry circuits or repetitive activation of unknown mechanism and focal spread.
Key Words: Human • atrium • fibrillation • mapping
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