Observational (n=253)
No
Absolute Event Rate: 136% vs 114%
p-value: p=<0.001
Atrial excitation during sinus rhythm is significantly altered by underlying heart disease and atrial fibrillation, leading to prolonged activation times and alternative conduction routes, particularly involving Bachmann's bundle.
AF history links to prolonged atrial activation in heart disease; leaves open whether mapping informs ablation or risk stratification.
Background The influence of underlying heart disease or presence of atrial fibrillation ( AF ) on atrial excitation during sinus rhythm ( SR ) is unknown. We investigated atrial activation patterns and total activation times of the entire atrial epicardial surface during SR in patients with ischemic and/or valvular heart disease with or without AF . Methods and Results Intraoperative epicardial mapping (N=128/192 electrodes, interelectrode distances: 2 mm) of the right atrium, Bachmann's bundle ( BB ), left atrioventricular groove, and pulmonary vein area was performed during SR in 253 patients (186 male [74%], age 66±11 years) with ischemic heart disease (N=132, 52%) or ischemic valvular heart disease (N=121, 48%). As expected, SR origin was located at the superior intercaval region of the right atrium in 232 patients (92%). BB activation occurred via 1 wavefront from right‐to‐left (N=163, 64%), from the central part (N=18, 7%), or via multiple wavefronts (N=72, 28%). Left atrioventricular groove activation occurred via (1) BB : N=108, 43%; (2) pulmonary vein area: N=9, 3%; or (3) BB and pulmonary vein area: N=136, 54%; depending on which route had the shortest interatrial conduction time ( P <0.001). Ischemic valvular heart disease patients more often had central BB activation and left atrioventricular groove activation via pulmonary vein area compared with ischemic heart disease patients (N=16 [13%] versus N=2 [2%]; P =0.009 and N=86 [71%] versus N=59 [45%]; P <0.001, respectively). Total activation times were longer in patients with AF ( AF : 136±20 [92–186] ms; no AF : 114±17 [74–156] ms; P <0.001), because of prolongation of right atrium ( P =0.018) and BB conduction times ( P <0.001). Conclusions Atrial excitation during SR is affected by underlying heart disease and AF , resulting in alternative routes for BB and left atrioventricular groove activation and prolongation of total activation times. Knowledge of atrial excitation patterns during SR and its electropathological variations, as demonstrated in this study, is essential to further unravel the pathogenesis of AF .
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Mouws et al. (2018) conducted an observational in Ischemic and/or valvular heart disease (n=253). Patients with atrial fibrillation vs. Patients without atrial fibrillation was evaluated on Total activation time of the entire atrial epicardial surface during sinus rhythm (p=<0.001).
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