Elisabeth M J P Mouws1, Eva A H Lanters1, Christophe P Teuwen1, Lisette J M E van der Does1, Charles Kik1, Paul Knops1, Jos A Bekkers1, Ad J J C Bogers1, Natasja M S de Groot2. 1. From the Department of Cardiology (E.M.J.P.M., E.A.H.L., C.P.T., L.J.M.E.v.d.D., P.K., N.M.S.d.G.) and Department of Cardiothoracic Surgery (E.M.J.P.M., C.K., J.A.B., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, The Netherlands. 2. From the Department of Cardiology (E.M.J.P.M., E.A.H.L., C.P.T., L.J.M.E.v.d.D., P.K., N.M.S.d.G.) and Department of Cardiothoracic Surgery (E.M.J.P.M., C.K., J.A.B., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, The Netherlands. nmsdegroot@yahoo.com.
Abstract
BACKGROUND: Epicardial breakthrough waves (EBW) during atrial fibrillation are important elements of the arrhythmogenic substrate and result from endo-epicardial asynchrony, which also occurs to some degree during sinus rhythm (SR). We examined the incidence and characteristics of EBW during SR and its possible value in the detection of the arrhythmogenic substrate associated with atrial fibrillation. METHODS AND RESULTS: Intraoperative epicardial mapping (interelectrode distances 2 mm) of the right atrium, Bachmann's bundle, the left atrioventricular groove, and the pulmonary vein area was performed during SR in 381 patients (289 male, 67±10 years) with ischemic or valvular heart disease. EBW were referred to as sinus node breakthrough waves if they were the earliest right atrial activated site. A total of 218 EBW and 57 sinus node breakthrough waves were observed in 168 patients (44%). EBW mostly occurred at right atrium (N=105, 48%) and left atrioventricular groove (N=67, 31%), followed by Bachmann's bundle (N=27, 12%) and pulmonary vein area (N=19, 9%; P<0.001). EBW occurred most often in ischemic heart disease patients (N=114, 49%) compared with (ischemic and) valvular heart disease patients (N=26, 17%; P<0.001). EBW electrograms most often consisted of double and fractionated potentials (N=137, 63%). In case of single potentials, an R wave was observed in 88% (N=71) of EBW, as opposed to 21% of sinus node breakthrough waves (N=5; P<0.001). Fractionated EBW potentials were more often observed at the right atrium and Bachmann's bundle (P<0.001). CONCLUSIONS: During SR, EBW are present in over a third of patients, particularly in thicker parts of the atrial wall. Features of SR EBW indicate that muscular connections between endo- and epicardium underlie EBW and that a slight degree of endo-epicardial asynchrony required for EBW to occur is already present in some areas during SR. Hence, an anatomic substrate is present, which may enhance the occurrence of EBW during atrial fibrillation, thereby promoting atrial fibrillation persistence.
BACKGROUND: Epicardial breakthrough waves (EBW) during atrial fibrillation are important elements of the arrhythmogenic substrate and result from endo-epicardial asynchrony, which also occurs to some degree during sinus rhythm (SR). We examined the incidence and characteristics of EBW during SR and its possible value in the detection of the arrhythmogenic substrate associated with atrial fibrillation. METHODS AND RESULTS: Intraoperative epicardial mapping (interelectrode distances 2 mm) of the right atrium, Bachmann's bundle, the left atrioventricular groove, and the pulmonary vein area was performed during SR in 381 patients (289 male, 67±10 years) with ischemic or valvular heart disease. EBW were referred to as sinus node breakthrough waves if they were the earliest right atrial activated site. A total of 218 EBW and 57 sinus node breakthrough waves were observed in 168 patients (44%). EBW mostly occurred at right atrium (N=105, 48%) and left atrioventricular groove (N=67, 31%), followed by Bachmann's bundle (N=27, 12%) and pulmonary vein area (N=19, 9%; P<0.001). EBW occurred most often in ischemic heart diseasepatients (N=114, 49%) compared with (ischemic and) valvular heart diseasepatients (N=26, 17%; P<0.001). EBW electrograms most often consisted of double and fractionated potentials (N=137, 63%). In case of single potentials, an R wave was observed in 88% (N=71) of EBW, as opposed to 21% of sinus node breakthrough waves (N=5; P<0.001). Fractionated EBW potentials were more often observed at the right atrium and Bachmann's bundle (P<0.001). CONCLUSIONS: During SR, EBW are present in over a third of patients, particularly in thicker parts of the atrial wall. Features of SR EBW indicate that muscular connections between endo- and epicardium underlie EBW and that a slight degree of endo-epicardial asynchrony required for EBW to occur is already present in some areas during SR. Hence, an anatomic substrate is present, which may enhance the occurrence of EBW during atrial fibrillation, thereby promoting atrial fibrillation persistence.
Authors: Eva A H Lanters; Christophe P Teuwen; Ameeta Yaksh; Charles Kik; Lisette J M E van der Does; Elisabeth M J P Mouws; Paul Knops; Nicole J van Groningen; Thijmen Hokken; Ad J J C Bogers; Natasja M S de Groot Journal: J Am Heart Assoc Date: 2018-03-10 Impact factor: 5.501
Authors: Elisabeth M J P Mouws; Eva A H Lanters; Christophe P Teuwen; Lisette J M E van der Does; Charles Kik; Paul Knops; Ameeta Yaksh; Jos A Bekkers; Ad J J C Bogers; Natasja M S de Groot Journal: J Am Heart Assoc Date: 2018-03-08 Impact factor: 5.501
Authors: Mathijs S van Schie; Roeliene Starreveld; Maarten C Roos-Serote; Yannick J H J Taverne; Frank R N van Schaagen; Ad J J C Bogers; Natasja M S de Groot Journal: Europace Date: 2020-10-01 Impact factor: 5.214
Authors: Mathijs S van Schie; Rohit K Kharbanda; Charlotte A Houck; Eva A H Lanters; Yannick J H J Taverne; Ad J J C Bogers; Natasja M S de Groot Journal: Circ Arrhythm Electrophysiol Date: 2021-06-18
Authors: Roeliene Starreveld; Paul Knops; Maarten Roos-Serote; Charles Kik; Ad J J C Bogers; Bianca J J M Brundel; Natasja M S de Groot Journal: J Cardiovasc Transl Res Date: 2020-05-14 Impact factor: 4.132
Authors: Rohit K Kharbanda; Paul Knops; Lisette J M E van der Does; Charles Kik; Yannick J H J Taverne; Maarten C Roos-Serote; Annejet Heida; Frans B S Oei; Ad J J C Bogers; Natasja M S de Groot Journal: J Am Heart Assoc Date: 2020-08-18 Impact factor: 5.501