Spontaneous atrial extrasystoles increased the median incidence of conduction delay (2.8% vs 1.2%) and block (2.2% vs 0.4%) compared to sinus rhythm, particularly with prematurely aberrant AES.
Observational (n=164)
Do spontaneous atrial extrasystoles increase the incidence of conduction delay and block compared to sinus rhythm in patients undergoing open-chest cardiac surgery?
Spontaneous atrial extrasystoles, particularly prematurely aberrant ones, significantly increase intra-atrial conduction delay and block compared to sinus rhythm, especially in patients with left atrial dilation and diabetes.
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.
Teuwen et al. (Fri,) conducted a observational in Patients undergoing open-chest cardiac surgery (n=164). Spontaneous atrial extrasystole (AES) vs. Sinus rhythm was evaluated on Incidence of conduction delay and conduction block. Spontaneous atrial extrasystoles increased the median incidence of conduction delay (2.8% vs 1.2%) and block (2.2% vs 0.4%) compared to sinus rhythm, particularly with prematurely aberrant AES.