Christophe P Teuwen1, Charles Kik1, Lisette J M E van der Does1, Eva A H Lanters1, Paul Knops1, Elisabeth M J P Mouws1, Ad J J C Bogers1, Natasja M S de Groot2. 1. From the Department of Cardiology (C.P.T., L.J.M.E.v.d.D., E.A.H.L., P.K., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., E.M.J.P.M., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands. 2. From the Department of Cardiology (C.P.T., L.J.M.E.v.d.D., E.A.H.L., P.K., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (C.K., E.M.J.P.M., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands. n.m.s.degroot@erasmusmc.nl.
Abstract
BACKGROUND: Atrial extrasystoles (AES) can initiate atrial fibrillation. However, the impact of spontaneous AES on intra-atrial conduction is unknown. The aims of this study were to examine conduction disorders provoked by AES and to correlate these conduction differences with patient characteristics, mapping locations, and type of AES. METHODS AND RESULTS: High-resolution epicardial mapping (electrodes N=128 or N=192; interelectrode distance, 2 mm) of the entire atrial surface was performed in patients (N=164; 69.5% male; age 67.2±10.5 years) undergoing open-chest cardiac surgery. AES were classified as premature, aberrant, or prematurely aberrant. Conduction delay and conduction block were quantified during sinus rhythm and AES and subsequently compared. Median incidence of conduction delay and conduction block during sinus rhythm was 1.2% (interquartile, 0%-2.3%) and 0.4% (interquartile, 0%-2.1%). In comparison, the median incidence of conduction delay and conduction block during 339 AES was respectively 2.8% (interquartile, 1.3%-4.6%) and 2.2% (interquartile, 0.3%-5.1%) and differed between the types of AES (prematurely aberrant>aberrant>premature). The degree of prematurity was not associated with a higher incidence of conduction disorders (P>0.05). In contrast, a higher degree of aberrancy was associated with a higher incidence of conduction disorders; AES emerging as epicardial breakthrough provoked most conduction disorders (P≥0.002). AES caused most conduction disorders in patients with diabetes mellitus and left atrial dilatation (P<0.05). CONCLUSIONS: Intraoperative high-resolution epicardial mapping showed that conduction disorders are mainly provoked by prematurely aberrant AES, particularly in patients with left atrial dilation and diabetes mellitus or emerging as epicardial breakthrough.
BACKGROUND:Atrial extrasystoles (AES) can initiate atrial fibrillation. However, the impact of spontaneous AES on intra-atrial conduction is unknown. The aims of this study were to examine conduction disorders provoked by AES and to correlate these conduction differences with patient characteristics, mapping locations, and type of AES. METHODS AND RESULTS: High-resolution epicardial mapping (electrodes N=128 or N=192; interelectrode distance, 2 mm) of the entire atrial surface was performed in patients (N=164; 69.5% male; age 67.2±10.5 years) undergoing open-chest cardiac surgery. AES were classified as premature, aberrant, or prematurely aberrant. Conduction delay and conduction block were quantified during sinus rhythm and AES and subsequently compared. Median incidence of conduction delay and conduction block during sinus rhythm was 1.2% (interquartile, 0%-2.3%) and 0.4% (interquartile, 0%-2.1%). In comparison, the median incidence of conduction delay and conduction block during 339 AES was respectively 2.8% (interquartile, 1.3%-4.6%) and 2.2% (interquartile, 0.3%-5.1%) and differed between the types of AES (prematurely aberrant>aberrant>premature). The degree of prematurity was not associated with a higher incidence of conduction disorders (P>0.05). In contrast, a higher degree of aberrancy was associated with a higher incidence of conduction disorders; AES emerging as epicardial breakthrough provoked most conduction disorders (P≥0.002). AES caused most conduction disorders in patients with diabetes mellitus and left atrial dilatation (P<0.05). CONCLUSIONS: Intraoperative high-resolution epicardial mapping showed that conduction disorders are mainly provoked by prematurely aberrant AES, particularly in patients with left atrial dilation and diabetes mellitus or emerging as epicardial breakthrough.
Authors: Annejet Heida; Willemijn F B van der Does; Mathijs S van Schie; Lianne N van Staveren; Yannick J H J Taverne; Ad J J C Bogers; Natasja M S de Groot Journal: Med Biol Eng Comput Date: 2022-10-12 Impact factor: 3.079
Authors: Gary Tse; Nan Zhang; Wenhua Song; Konstantinos P Letsas; Tachapong Ngarmukos; Kamalan Jeevaratnam; Tong Liu Journal: Front Cardiovasc Med Date: 2022-04-27
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