Key result
Paroxysmal AF history in mitral valve disease links to ~28% lower Bachmann's bundle S-wave amplitudes.
Why the study?
Unipolar single potential morphology reflects intra-atrial conduction disorders and potential atrial fibrillation substrate, but the impact of AF episodes on these features during sinus rhythm in mitral valve disease was unknown.
Does a history of paroxysmal atrial fibrillation alter unipolar single potential morphology during sinus rhythm in patients with mitral valve disease?
Observational (n=67)
Does a history of paroxysmal atrial fibrillation alter unipolar single potential morphology during sinus rhythm in patients with mitral valve disease?
Absolute Event Rate: 2.94% vs 4.08%
p-value: p=<0.001
In patients with mitral valve disease, a history of paroxysmal atrial fibrillation is associated with decreased single potential amplitudes and conduction velocity at Bachmann's bundle during sinus rhythm.
Signals potential substrate changes in mitral valve disease; hypothesis-generating and requires prospective validation before clinical use.
AIMS: The morphology of unipolar single potentials (SPs) contains information on intra-atrial conduction disorders and possibly the substrate underlying atrial fibrillation (AF). This study examined the impact of AF episodes on features of SP morphology during sinus rhythm (SR) in patients with mitral valve disease. METHODS AND RESULTS: Intraoperative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium (RA, LA), Bachmann's bundle (BB), and pulmonary vein area (PVA) was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). Unipolar SPs were classified according to their differences in relative R- and S-wave amplitude ratios. A clear predominance of S-waves was observed at BB and the RA in both the no AF and PAF groups (BB 88.8% vs. 85.9%, RA 92.1% vs. 85.1%, respectively). Potential voltages at the RA, BB, and PVA were significantly lower in the PAF group (P < 0.001 for each) and were mainly determined by the size of the S-waves amplitudes. The largest difference in S-wave amplitudes was found at BB; the S-wave amplitude was lower in the PAF group [4.08 (2.45-6.13) mV vs. 2.94 (1.40-4.75) mV; P < 0.001]. In addition, conduction velocity (CV) at BB was lower as well [0.97 (0.70-1.21) m/s vs. 0.89 (0.62-1.16) m/s, P < 0.001]. CONCLUSION: Though excitation of the atria during SR is heterogeneously disrupted, a history of AF is characterized by decreased SP amplitudes at BB due to loss of S-wave amplitudes and decreased CV. This suggests that SP morphology could provide additional information on wavefront propagation.
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Schie et al. (2020) conducted an observational in Mitral valve disease (n=67). History of paroxysmal atrial fibrillation vs. No history of atrial fibrillation was evaluated on S-wave amplitude at Bachmann's bundle (p=<0.001). In patients with mitral valve disease, a history of paroxysmal AF was associated with decreased S-wave amplitudes at Bachmann's bundle (2.94 vs 4.08 mV; P<0.001) and lower conduction velocity.
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