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November 9, 2004Circulation

A significant left-to-right atrial dominant frequency gradient was observed in paroxysmal AF (6.2 Hz at PV/LA vs 5.1 Hz at RA; P<0.001), but not in persistent AF.

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Why the study?

Does a left-to-right atrial frequency gradient exist in human paroxysmal and persistent atrial fibrillation?

Population

31 patients aged 56.7+/-10.5 years with a history of paroxysmal or persistent atrial fibrillation.

Comparison

Electrophysiological recordings at each… vs Comparison between paroxysmal and persistent AF…

Design

Cross-sectional

Key result

A significant left-to-right atrial dominant frequency gradient was observed in paroxysmal AF (6.2 Hz at PV/LA vs 5.1 Hz at RA; P<0.001), but not in persistent AF.

Authors

SLSorin LazarSDSanjay DixitFMFrancis E. Marchlinski

Discussion

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Overview

Gradient specific to paroxysmal AF supports left atrial drivers; hypothesis-generating and should not yet alter ablation practice.

Key Points

  • The study aims to determine the presence of a left-to-right atrial frequency gradient in humans with paroxysmal atrial fibrillation.
  • Included 31 patients aged 56.7±10.5 years with paroxysmal or persistent AF.
  • Measured dominant frequencies at pulmonary vein ostium, coronary sinus, and right atrium using fast Fourier transforms.
  • Qualified patients into groups of 18 with paroxysmal AF and 13 with persistent AF.
  • In the paroxysmal AF group, average dominant frequencies (DF) were 6.2 Hz (PV/LA), 5.5 Hz (CS), and 5.1 Hz (RA), P<0.001.
  • No significant DF difference in the persistent AF group, with averages of 6.1 Hz (LA/PV), 5.8 Hz (CS), and 5.8 Hz (RA), P=NS.
  • Results suggest the posterior left atrium may be crucial in maintaining paroxysmal AF.

Study Design

Type

Observational (n=31)

Structured PICO

Does a left-to-right atrial frequency gradient exist in human paroxysmal and persistent atrial fibrillation?

P
Population
31 patients aged 56.7+/-10.5 years with a history of paroxysmal (n=18) or persistent (>1 month, n=13) atrial fibrillation.
I
Intervention
Electrophysiological recordings at each pulmonary vein (PV) ostium, coronary sinus (CS), and posterior right atrium (RA) during AF with sequential fast Fourier transforms to determine dominant frequency.
C
Comparator
Comparison between paroxysmal and persistent AF groups, and across different atrial sites.
O
Outcome
Dominant frequency (DF) at the PV/LA junction, CS, and RA.surrogate

Main Result

p-value: p=<0.001

A left-to-right atrial dominant frequency gradient exists in paroxysmal but not persistent atrial fibrillation, suggesting the posterior left atrium plays a key role in maintaining paroxysmal AF.

Cite This Study

Lazar et al. (2004) conducted an observational in Paroxysmal or persistent atrial fibrillation (n=31). Electrophysiological mapping vs. Paroxysmal vs persistent AF was evaluated on Dominant frequency (DF) gradient from left to right atrium (p=<0.001). A significant left-to-right atrial dominant frequency gradient was observed in paroxysmal AF (6.2 Hz at PV/LA vs 5.1 Hz at RA; P<0.001), but not in persistent AF.

synapsesocial.com/papers/6a086962afa0a1b8dbddf683https://doi.org/10.1161/01.cir.0000147279.91094.5e
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left-to-Right Gradient of Atrial Frequencies During Acute Atrial Fibrillation in the Isolated Sheep Heart2001 · 381 citations
  2. 2In-silico study of the ionic current gradients determining left-to-right atrial frequencies during paroxysmal atrial fibrillation2019 · 2 citations
  3. 3Centrifugal Gradients of Rate and Organization in Human Atrial Fibrillation2009 · 28 citations
  4. 4Left-to-Right Atrial Inward Rectifier Potassium Current Gradients in Patients With Paroxysmal Versus Chronic Atrial Fibrillation2010 · 222 citations
  5. 5Dominant frequency differences in atrial fibrillation patients with and without left ventricular systolic dysfunction2008 · 15 citations