Electrophysiologic testing detects abnormalities in atrial refractoriness and conduction in patients with paroxysmal atrial fibrillation, but lacks sufficient diagnostic sensitivity and specificity.
Does electrophysiologic testing accurately identify atrial vulnerability in patients with paroxysmal atrial flutter and fibrillation?
Electrophysiologic testing reveals abnormalities in patients with paroxysmal AFF, but current parameters lack the sensitivity and specificity needed for routine clinical diagnostic use.
The electrophysiologic substrates of atrial flutter and fibrillation (AFF) have been studied in patients with paroxysmal arrhythmias. Atrial repetitive responses to extrastimuli are a nonspecific response, even though they can precipitate AFF. AFF inducibility is rather sensitive, but not very specific, in separating patients from controls. There is no established protocol to explore vulnerability in this fashion. Atrial refractoriness is abnormal in some patients. Some authors have found a tendency toward short effective refractory periods (AERP) and others have found a poor adaptation of AERP to decreases in cycle length. Unfortunately, these abnormalities are neither sensitive nor specific enough. Atrial conduction may be abnormal basally, but subtler abnormalities are shown by premature stimulation. Early extrastimuli are conducted with increased conduction delays in patients with paroxysmal AFF in relation to controls. Again, there is not enough sensitivity and specificity in the findings to make them of diagnostic value. Electrophysiologic abnormalities are detectable in patients with AFF, but larger studies, including reproducibility and the effect of drugs on the abnormal parameters, will be necessary to develop clinical applications.
Francisco G. Cosío (Sun,) conducted a review in Atrial flutter and fibrillation. Electrophysiologic testing vs. Controls was evaluated on Electrophysiologic abnormalities. Electrophysiologic testing detects abnormalities in atrial refractoriness and conduction in patients with paroxysmal atrial fibrillation, but lacks sufficient diagnostic sensitivity and specificity.