Arrhythmogenic Difference Between the Left and Right Atria During Rapid Atrial Activation in a Canine Model of Atrial Fibrillation

BACKGROUND: Continuous rapid atrial stimulation causes atrial remodeling, but little is known about the difference in the arrhythmogenicity of the left (LA) and right atria (RA). METHODS AND RESULTS: In 14 beagle dogs, continuous rapid pacing (400 beats/min) was delivered from the right (n=7) or left (n=7) atrial appendage (RAA or LAA) for 2 weeks. The atrial effective refractory period (ERP), ERP dispersion, and inducibility of atrial fibrillation (AF) were evaluated along the time course from 4 atrial sites: (1) RAA, (2) area close to the inferior vena cava (IVC), (3) Bachmann's bundle (BB) and (4) LA. The ERP exhibited progressive shortening at all sites, but the degree of shortening differed among them. In the RA stimulation group, ERP shortening was more prominent in the RAA and LA than in the IVC or BB. In contrast, in the LA stimulation group, ERP shortening was more prominent in the LA than in the other sites. As a result, ERP dispersion was larger in the LA stimulation group than in the RA stimulation group and the AF inducibility was higher in the LA stimulation group than in the RA stimulation group, especially at the LA site (p<0.05). CONCLUSION: LAA stimulation was more arrhythmogenic than RAA stimulation in this model. This result may partly explain the importance of premature contractions occurring from the pulmonary veins in clinical cases of AF.