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Type: Journal article
Title: Anatomically determined functional conduction delay in the posterior left atrium: Relationship to structural heart disease
Author: Roberts-Thomson, K.
Stevenson, I.
Kistler, P.
Haqqani, H.
Goldblatt, J.
Sanders, P.
Kalman, J.
Citation: Journal of the American College of Cardiology, 2008; 51(8):856-862
Publisher: Elsevier Science Inc
Issue Date: 2008
ISSN: 0735-1097
Statement of
Kurt C. Roberts-Thomson, Irene H. Stevenson, Peter M. Kistler, Haris M. Haqqani, John C. Goldblatt, Prashanthan Sanders and Jonathan M. Kalman
Abstract: OBJECTIVES: This study sought to characterize the conduction properties of the posterior left atrium (PLA) in patients with different forms of structural heart disease undergoing cardiac surgery. BACKGROUND: The PLA plays an important role in the initiation and maintenance of atrial fibrillation. METHODS: This study included 34 patients having elective cardiac surgery. There were 4 groups of patients: normal left ventricular (LV) function (coronary artery bypass grafting [CABG]); severe LV dysfunction (LVF/CABG); severe mitral regurgitation (MR); severe aortic stenosis (AS). Epicardial mapping of the PLA was performed in sinus rhythm and during differential pacing. Activation patterns, regional conduction velocity (CV), conduction heterogeneity, anisotropy, and total plaque activation time (TAT) were assessed. RESULTS: Left atrial size in patients with LVF/CABG (47 +/- 7 mm) and MR (54 +/- 6 mm) was larger than patients with CABG (39 +/- 7 mm) and AS (42 +/- 6 mm; p < 0.05). During pacing, all patients developed a vertical line of conduction delay running between the pulmonary veins. The extent of this conduction delay was greater in patients with LVF/CABG and MR than patients with AS and CABG (p < 0.05). Conduction heterogeneity, anisotropy, and TAT were greater in patients with LVF/CABG and MR than patients with CABG (p < 0.05). These changes resulted in circuitous wave front propagation. CONCLUSIONS: There is a line of functional conduction delay in a consistent anatomical location in the PLA in patients with structural heart disease. This is most marked in conditions associated with significant chronic atrial enlargement and leads to circuitous wave front propagation, suggesting a potential role in arrhythmogenesis.
Keywords: Heart Atria; Heart Conduction System; Humans; Atrial Fibrillation; Heart Valve Diseases; Electrophysiology; Time Factors; Aged; Middle Aged; Female; Male; Coronary Artery Disease
Description: Copyright © 2008 American College of Cardiology Foundation Published by Elsevier Inc.
RMID: 0020080173
DOI: 10.1016/j.jacc.2007.11.037
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