European Heart Journal Advance Access published online on July 10, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn329
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Electrical remodelling of the left and right atria due to rheumatic mitral stenosis
1 Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide, Australia
2 Department of Cardiology, Christian Medical College, Vellore, India
3 Institute of Cardiology, Warsaw, Poland
4 Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Victoria, Australia
Received 21 December 2007; revised 17 June 2008; accepted 19 June 2008.
* Corresponding author. Tel: +61 8 8222 2723, Fax: +61 8 8222 2722, Email: prash.sanders{at}adelaide.edu.au
Aims: To characterize the atrial remodelling in mitral stenosis (MS).
Methods and results: Twenty-four patients with severe MS undergoing commissurotomy and 24 controls were studied. Electrophysiological evaluation was performed in 12 patients in each group by positioning multi-electrode catheters in both atria to determine the following: effective refractory period (ERP) at 10 sites at 600 and 450 ms; conduction time; conduction delay at the crista terminalis (CT); and vulnerability for atrial fibrillation (AF). P-wave duration (PWD) was determined on the surface ECG. In the remaining 12 patients in each group, electroanatomic maps of both atria were created to determine conduction velocity and identify regions of low voltage and electrical silence. Patients with MS had larger left atria (LA) (P < 0.0001); prolonged PWD (P = 0.0007); prolonged ERP in both LA (P < 0.0001) and right atria (RA) (P < 0.0001); reduced conduction velocity in the LA (P = 0.009) and RA (P < 0.0001); greater number (P < 0.0001) and duration (P< 0.0001) of bipoles along the CT with delayed conduction; lower atrial voltage in the LA (P < 0.0001) and RA (P < 0.0001); and more frequent electrical scar (P = 0.001) compared with controls. Five of twelve with MS and none of the controls developed AF with extra-stimulus (P = 0.02).
Conclusion: Atrial remodelling in MS is characterized by LA enlargement, loss of myocardium, and scarring associated with widespread and site-specific conduction abnormalities and no change or an increase in ERP. These abnormalities were associated with a heightened inducibility of AF.
Key Words: Rheumatic mitral stenosis • Atrial remodelling • Atrial fibrillation
Presented in part by Dr John and received Young Investigator Award at the 2nd Asia-Pacific AF Symposium, November 2006, Tokyo, Japan; and at the Heart Rhythm Society's 27th Annual Scientific Sessions, May 2006, Boston, USA and published in abstract form (Heart Rhythm 2006; 3: S194).
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