CLINICAL STUDY: ELECTROPHYSIOLOGY
Electrophysiologic characteristics in initiation of paroxysmal atrial fibrillation from a focal area
Tse-Min Lu, MD ,
Ching-Tai Tai, MD* ,
Ming-Hsiung Hsieh, MD*,
Chin-Feng Tsai, MD*,
Yung-Kuo Lin, MD,
Wen-Chung Yu, MD* ,
Hsuan-Ming Tsao, MD,
Shih-Huang Lee, MD*,
Yu-An Ding, MD* ,
Mau-Song Chang, MD* and
Shih-Ann Chen, MD*
* Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan, People's Republic of China
Division of Cardiology, Veterans General Hospital, Taipei, Taiwan, People's Republic of China
Manuscript received March 20, 2000;
revised manuscript received December 28, 2000,
accepted January 24, 2001.
Reprint requests and correspondence: Dr. Shih-Ann Chen, Division of Cardiology, Veteran General Hospital-Taipei, 201 Sec 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
epsachen{at}ms41.hinet.net
OBJECTIVES
We investigated the electrophysiologic characteristics in the initiation of paroxysmal atrial fibrillation (PAF) from a focal area.
BACKGROUND
The electrophysiologic characteristics in the initiation of PAF are still not clear.
METHODS
The study group consisted of 77 patients (M/F = 65/12, age 66 ± 12 years) with frequent episodes of PAF; we analyzed: 1) 15 cycle lengths of electrical activity before the onset of atrial fibrillation (AF); 2) coupling interval (CI) of the first ectopic beat just before the initiation of AF; and 3) the prematurity of an ectopic beat (prematurity index [PI] = CI/mean of preceding 15 cycle lengths).
RESULTS
A total of 111 episodes of sustained AF were identified. Two patterns of AF initiation were observed: group I (59/111, 53%) included the episodes preceded by cycle length oscillation, and group II (52/111, 47%) included the episodes initiated by a single ectopic beat with preceding cycle length relatively constant. The PI of group I episodes was significantly greater than that of group II (0.41 ± 0.12 vs. 0.34 ± 0.10, p < 0.01). The CI (267 ± 54 ms vs. 217 ± 55 ms, p < 0.05), AF1 (194 ± 36 ms vs. 153 ± 37 ms, p < 0.05) and PI (0.49 ± 0.13 vs. 0.37 ± 0.11, p < 0.01) of the AF episodes from the superior vena cava (SVC) were significantly longer and greater than those of AF episodes from pulmonary veins (PVs).
CONCLUSIONS
In patients with PAF originating from PVs or the SVC, two major initiating patterns were found. Moreover, the electrophysiologic characteristics in the initiation of AF originating from the SVC were also different from those of AF initiating from the PVs.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | AF1 | = first cycle length of AF | | CI | = coupling interval | | ECG | = electrocardiogram | | LA | = left atrium | | LSPV | = left superior pulmonary veins | | PAF | = paroxysmal atrial fibrillation | | PI | = prematurity index | | PV | = pulmonary vein | | RSPV | = right superior pulmonary veins | | SVC | = superior vena cava |
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