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https://hdl.handle.net/2440/131915
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Type: | Journal article |
Title: | Functional atrial endocardial–epicardial dissociation in patients with structural heart disease undergoing cardiac surgery |
Author: | Parameswaran, R. Teuwen, C.P. Watts, T. Nalliah, C.J. Royse, A. Goldblatt, J. Larobina, M. Sanders, P. Kistler, P. Orozco-Duque, A. Lee, G. Kalman, J.M. |
Citation: | JACC: Clinical Electrophysiology, 2020; 6(1):34-44 |
Publisher: | Elsevier |
Issue Date: | 2020 |
ISSN: | 2405-500X 2405-5018 |
Statement of Responsibility: | Ramanathan Parameswaran, Christophe P. Teuwen, Troy Watts, Chrishan J. Nalliah, Alistair Royse, John Goldblatt ... et al. |
Abstract: | OBJECTIVES:The goal of this study was to describe functional endocardial-epicardial dissociation (FEED), signal complexities, and three-dimensional activation dynamics of the human atrium with structural heart disease (SHD). BACKGROUND:SHD commonly predisposes to arrhythmias. Although progressive remodeling is implicated, direct demonstration of FEED in the human atrium has not been reported previously. METHODS:Simultaneous intraoperative mapping of the endocardial and epicardial lateral right atrial wall was performed by using 2 high-density grid catheters during sinus rhythm, pacing drive (600 ms and 400 ms cycle length), and premature extrastimulation (PES). Unipolar electrograms (EGMs) were exported into custom-made software for activation and phase mapping. Difference of ≥20 ms between paired endocardial and epicardial electrodes defined dissociation. EGMs with ≥3 deflections were classified as fractionated. RESULTS:Sixteen patients (mean age 60.5 ± 4.1 years; 18.7% with a history of atrial fibrillation) with SHD (43% ischemia, 57% valvular disease) were included. A total of 9,218 EGMs were analyzed. Compared with sinus rhythm, phase and activation analyses showed significant FEED during pacing at 600 ms and 400 ms (phase mapping 22.4% vs. 10% [p < 0.0001] and 25.8% vs. 10% [p < 0.0001], respectively; activation mapping 25.4% vs. 7.8% [p < 0.0001] and 27.7% vs. 7.8% [p < 0.0001]) and PES (phase mapping 34% vs. 10% [p < 0.0001]; activation mapping 29.5% vs. 7.8% [p < 0.0001]). Fractionated EGMs occurred significantly more during PES compared with sinus rhythm (50.2% vs. 39.5%; p < 0.0001). Activation patterns differed significantly during pacing drive and PES, with preferential epicardial exit during the latter (15.9% vs. 13.8%; p = 0.046). CONCLUSIONS:Simultaneous endocardial-epicardial mapping revealed significant FEED with signal fractionation and preferential epicardial breakthroughs with PES. Such complex three-dimensional interaction in electrical activation provides mechanistic insights into atrial arrhythmogenesis with SHD. |
Keywords: | arrhythmogenesis electrogram morphology epicardial–endocardial mapping fractionation functional dissociation structural heart disease |
Rights: | © 2020 BY THE AMERICAN COLLEGEOF CARDIOLOGY FOUNDATION |
DOI: | 10.1016/j.jacep.2019.08.016 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1016/j.jacep.2019.08.016 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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