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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Frequency Analysis in Different Types of Paroxysmal Atrial Fibrillation

Yenn-Jiang Lin, MD^_*,, Ching-Tai Tai, MD^_*, Tsair Kao, PhD, Han-Wen Tso, MS, Satoshi Higa, MD^_*, Hsuan-Ming Tsao, MD^_*, Shih-Lin Chang, MD^_*,, Ming-Hsiung Hsieh, MD^_*, and Shih-Ann Chen, MD^_*,,_*

^_* Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Institute of Clinical Medicine and Cardiovascular Research, National Yang-Ming University, Taipei, Taiwan
Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan

Manuscript received July 14, 2005; revised manuscript received October 25, 2005, accepted October 31, 2005.

^_* Reprint requests and correspondence: Dr. Shih-Ann Chen, Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan (Email: epsachen{at}ms41.hinet.net).

OBJECTIVES: This study sought to investigate the regional frequency distribution from multiple bi-atrial sites in different types of paroxysmal atrial fibrillation (AF).

BACKGROUND: A previous study showed a left atrium (LA) to right atrium (RA) frequency gradient in patients with paroxysmal AF.

METHODS: Forty-four patients (age = 60 ± 16, male patients = 27) with paroxysmal AF originating from the pulmonary veins (PVs) (n = 31) or superior vena cava (SVC) (n = 13) were included. Frequency analysis was performed on the intracardiac electrograms (7 s, 1 kHz/channel) recorded from PV, posterior LA, coronary sinus (CS), posterolateral RA, and SVC. The largest peak frequency was identified as the dominant frequency (DF).

RESULTS: In the PV-AF patients, there was a frequency gradient from the PV ostium to the LA, RA, and SVC (8.5 ± 3.3 Hz vs. 5.9 ± 1.1 Hz vs. 5.2 ± 0.85 Hz vs. 5.5 ± 0.48 Hz, respectively, p < 0.001). The highest DFs were mostly located at the arrhythmogenic PV ostium (58%). The DFs of the arrhythmogenic PV and PV ostium were significantly higher than those of the non-arrhythmogenic PVs and PV ostia (p < 0.05). In the SVC-AF patients, there was a frequency gradient from the SVC to the RA, LA, and PV (8.0 ± 2.4 Hz vs. 5.9 ± 1.1 Hz vs. 5.9 ± 0.7 Hz vs. 5.8 ± 0.7 Hz, respectively, p = 0.001). The highest DFs were mostly located inside the SVC (77%) instead of the SVC ostium (as compared with PV-AF patients, p = 0.035).

CONCLUSIONS: The location of the highest DF depended on the arrhythmogenic PV or SVC. A frequency gradient was present between the arrhythmogenic thoracic vein and atrium in all patients.

Abbreviations and Acronyms   AF = atrial fibrillation   CS = coronary sinus   DF = dominant frequency   LA = left atrium/atrial   LIPV = left inferior pulmonary vein   LSPV = left superior pulmonary vein   PV = pulmonary vein   RA = right atrium/atrial   RIPV = right inferior pulmonary vein   RSPV = right superior pulmonary vein   SVC = superior vena cava

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