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European Heart Journal 1999 20(12):888-895; doi:10.1053/euhj.1998.1404
Copyright © 1999 by the European Society of Cardiology.
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Alterations in atrial electrophysiology associated with chronic atrial fibrillation in man

K. Kamalvandf1, K. Tan, G. Lloyd, J. Gill, C. Bucknall and N. Sulke

Department of Cardiology, Guy’s Hospital, London, U.K.

revised October 26, 1998; accepted October 28, 1998

Abstract

Background The purpose of this study was to determine the changes in atrial electrophysiology associated with chronic persistent atrial fibrillation in man.

Methods and Results Atrial monophasic action potential duration at 90% repolarization and the effective refractory period were measured in 13 patients with chronic persistent atrial fibrillation after low-energy endocardial cardioversion, and compared to eight controls without a history of atrial fibrillation. Measurements were made at the right atrial appendage and midlateral right atrial wall at basic, 600ms and 400ms drive cycle lengths. In control patients, the effective refractory periods were significantly longer at the atrial appendage than the lateral wall at 600ms (right atrial appendage 265ms, midlateral right atrial wall 228ms, P<0·05), and 400ms cycle lengths (right atrial appendage 270ms, midlateral right atrial wall 218ms, P<0·05), but this was not evident in patients with atrial fibrillation. The monophasic action potentials and effective refractory periods at both atrial sites were shorter in the atrial fibrillation patients compared to controls; however, only the effective refractory periods at atrial appendage at 600ms (atrial fibrillation 210ms, controls 265ms, P<0·001), and 400ms cycle lengths (atrial fibrillation 200ms, controls 270ms, P>0·001) reached statistical significance. Effective refractory period dispersion was significantly greater in controls than in patients with atrial fibrillation (cycle length 600ms: controls 36, atrial fibrillation 13, P=0·01; cycle length 400ms: controls 54, atrial fibrillation 18, P<0·01).

Conclusions In patients without a history of atrial fibrillation, the refractory period at the right atrial appendage is significantly longer than at the midlateral right atrial wall. This ‘normal’ pattern of atrial refractory dispersion is lost in patients with chronic persistent atrial fibrillation, with marked shortening of the effective refractory period at the right atrial appendage. This may explain the high risk of recurrence of atrial fibrillation following successful electrical cardioversion.

Key Words: Atrium • fibrillation • electrophysiology

f1 Correspondence : Dr Kayvan Kamalvand, Department of Medicine, William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent TN24 0LZ, U.K.

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