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Structural remodeling and conduction velocity dynamics in the human left atrium: relationship with reentrant mechanisms sustaining atrial fibrillation

Honarbakhsh, S; Schilling, RJ; Orini, M; Providencia, R; Keating, E; Finlay, M; Sporton, S; ... Hunter, RJ; + view all (2019) Structural remodeling and conduction velocity dynamics in the human left atrium: relationship with reentrant mechanisms sustaining atrial fibrillation. Heart Rhythm , 16 (1) pp. 18-25. 10.1016/j.hrthm.2018.07.019. Green open access

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Abstract

BACKGROUND: Rate-dependent conduction velocity (CV) slowing is associated with atrial fibrillation (AF) initiation and reentry mechanisms. OBJECTIVES: Assess the relationship between bipolar voltage, CV dynamics and AF drivers. METHODS: Patients undergoing catheter ablation for persistent AF (<24 months) were enrolled. Unipolar electrograms were recorded with a 64-pole basket catheter during atrial pacing at four pacing intervals (PIs) during sinus rhythm. CVs were measured between pole pairs along the wavefront path and correlated with underlying bipolar voltage. CV dynamics within low voltage zones (LVZs<0.5mV) were compared to those of non-LVZs (≥0.5mV) and were correlated to driver sites mapped using CARTOFINDER. RESULTS: Eighteen patients were included (age 62±10yrs). Mean CV at 600ms was 1.59±0.13m/s vs. 0.98±0.23m/s, in non-LVZs and LVZs respectively (p<0.001). CV decreased incrementally over all four-PIs in LVZs whilst in non-LVZs a substantial decrease in CV was only seen between PI 300-250ms CLs (0.59±0.09m/s; p<0.001). Rate-dependent CV slowing sites measurements, defined as exhibiting a CV reduction ≥20% more than the mean CV reduction seen between PIs 600-250ms for that voltage zone were predominantly in LVZs (0.2-0.5mV, 75.6±15.5%; p<0.001). Confirmed rotational drivers were mapped to these sites in 94.1% of cases (sensitivity 94.1%, 95%CI 71.3- 99.9% and specificity 77.9%, 95%CI 74.9-80.7%). CONCLUSIONS: CV dynamics are determined largely by the extent of remodeling. Rate-dependent CV slowing sites are predominantly confined to LVZs [0.2-0.5 mV] and the resultant CV heterogeneity may promote driver formation in AF.

Type: Article
Title: Structural remodeling and conduction velocity dynamics in the human left atrium: relationship with reentrant mechanisms sustaining atrial fibrillation
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.hrthm.2018.07.019
Publisher version: https://doi.org/10.1016/j.hrthm.2018.07.019
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Keywords: Conduction velocity, atrial fibrillation, bipolar voltage, drivers, structural remodeling
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10054022
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