Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease: Longitudinal Dissociation
Open accessAbstract
BACKGROUND: The electropathological substrate of persistent atrial fibrillation (AF) in humans is largely unknown. The aim of this study was to compare the spatiotemporal characteristics of the fibrillatory process in patients with normal sinus rhythm and long-standing persistent AF. METHODS AND RESULTS: During cardiac surgery, epicardial mapping (244 electrodes) of the right atrium (RA), the left lateral wall (LA), and the posterior left atrium (PV) was performed in 24 patients with long-standing persistent AF. Twenty-five patients with normal sinus rhythm, in whom AF was induced by rapid pacing, served as a reference group. A mapping algorithm was developed that separated the complex fibrillation process into its individual elements (wave mapping). Parameters used to characterize the substrate of AF were (1) the total length of interwave conduction block, (2) the number of fibrillation waves, and (3) the ratio of block to collision of fibrillation waves (dissociation index). In 4403 maps of persistent AF, no evidence for the presence of stable foci or rotors was found. Instead, many narrow wavelets propagated simultaneously through the atrial wall. The lateral boundaries of these waves were formed by lines of interwave conduction block, predominantly oriented parallel to the atrial musculature. Lines of block were not fixed but continuously changed on a beat-to-beat basis. In patients with persistent AF, the total length of block in the RA was more than 6-fold higher than during acute AF (median, 21.1 versus 3.4 mm/cm(2); P<0.0001). The highest degree of interwave conduction block was found in the PV area (33.0 mm/cm(2)). The number of fibrillation waves during persistent AF was 4.5/cm(2) compared with 2.3 during acute AF, and the dissociation index was 7.3 versus 1.5 (P<0.0001). The interindividual variation of these parameters among patients was high. CONCLUSIONS: Electric dissociation of neighboring atrial muscle bundles is a key element in the development of the substrate of human AF. The degree of the pathological changes can be measured on an individual basis by electrophysiological parameters in the spatial domain.
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Structural remodelling results in electrical dissociation between muscle bundles and local conduction heterogeneities, favouring reentry and perpetuation of the arrhythmia.
“Structural remodelling results in electrical dissociation between muscle bundles and local conduction heterogeneities, 85 favouring reentry and perpetuation of the arrhythmia.86”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [85]
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- Authors
- Allessie, M. A., de Groot, N. M. S., Houben, R. P. M., Schotten, U., Boersma, E., Smeets, J. L., & Crijns, H. J.
- Affiliations
- Maastricht University Medical Centre (NL)
- From the Department of Physiology (M.A.A., N.M.S.d.G., U.S.), Cardiovascular Research Institute Maastricht; Medtronic Bakken Research Center Maastricht (R.P.M.H.), Maastricht, The Netherlands; the Department of Cardiology (J.L.S., H.J.C.), Maastricht UMC, Maastricht, The Netherlands; and the Department of Cardiology (E.B.), Erasmus MC, Rotterdam, The Netherlands.
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2010-12
- Volume
- 3
- Issue
- 6
- Pages
- 606-615
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2103101898
- Cited by
- 450
- References
- 26
- Citations by year
- 2026: 21 · 2025: 12 · 2024: 19 · 2023: 16 · 2022: 18 · 2021: 32 · 2020: 38 · 2019: 31 · 2018: 32 · 2017: 54 · 2016: 41 · 2015: 30 · 2014: 32 · 2013: 30 · 2012: 31
- FWCI
- 16.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Universiteit Maastricht
- Maastricht Universitair Medisch Centrum
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- long-standing persistent atrial fibrillation, atrial fibrillation substrate, structural heart disease, epicardial mapping, wavelets, atrial electrophysiology, atrial remodeling
- MeSH terms
- Adult, Atrial Fibrillation, Coronary Artery Disease, Follow-Up Studies, Heart Conduction System, Cardiac Surgical Procedures, Heart Valve Diseases, Humans, Male, Middle Aged, Pericardium, Severity of Illness Index, Monitoring, Intraoperative, Body Surface Potential Mapping
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