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European Heart Journal 2001 22(19):1822-1834; doi:10.1053/euhj.2001.2607
Copyright © 2001 by the European Society of Cardiology.
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Role of dispersion of atrial refractoriness in the recurrence of clinical atrial fibrillation. A manifestation of atrial electrical remodelling in humans?

S.P Fynn, D.M Todd, W.J.C Hobbs, K.L Armstrong and C.J Garrattf1

Manchester Heart Centre, Manchester Royal Infirmary, Manchester, U.K.

revised January 16, 2001; accepted January 17, 2001

Abstract

Aims The mechanism of atrial fibrillation recurrence following cardioversion is unknown, although experimental studies have indicated that changes in dispersion of atrial refractoriness may play a role. The aims of this study were to assess (1) if dispersion of atrial refractoriness is relevant to atrial fibrillation recurrence and (2) if dispersion of refractoriness is part of the atrial electrical remodelling process in humans.

Methods and Results Thirty-seven consecutive patients underwent internal cardioversion (CV1) of persistent atrial fibrillation. Patients were monitored by daily transtelephonic recordings following discharge and if there was spontaneous atrial fibrillation recurrence they were rapidly admitted for repeat cardioversion (CV2). We used the 5th percentile of 100 consecutive atrial fibrillation cycle lengths (AFCLP5) and the atrial effective refractory period (AERP) as measures of atrial refractoriness at four different atrial sites. Dispersion of AFCLP5at CV1 was significantly higher in those who had subsequent recurrence of atrial fibrillation than in those who remained in sinus rhythm for at least 1 month after cardioversion (35±17ms vs 9±13ms;P<0·02). Dispersion of AFCLP5measured at CV2 was significantly lower than that measured in the same patients at CV1 (19±8ms vs 35±11ms;P=0·02). i.e. dispersion of AFCLP5had reduced following a period of sinus rhythm. In contrast, there was no difference in dispersion of AERP between the recurrers and non-recurrers. Dispersion of AERP between CV1 and CV2 did not change following a period of sinus rhythm.

Conclusion Dispersion of AFCL is relevant to atrial fibrillation recurrence and may represent a manifestation of atrial electrical remodelling in humans. Treatment directed at AFCL dispersion may be useful in the suppression of atrial fibrillation recurrence following cardioversion.

Key Words: Atrial electrical remodelling, atrial fibrillation, atrial fibrillation cycle length, cardioversion, dispersion of atrial refractoriness

f1 Correspondence: Clifford J. Garratt DM, Manchester Heart Centre, Oxford Road, Manchester M13 9WL, U.K.

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