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Conduction characteristics at the crista terminalis during onset of pulmonary vein atrial fibrillation.
J Cardiovasc Electrophysiol. 2004 Aug; 15(8):855-61.JC

Abstract

INTRODUCTION

Focal atrial fibrillation (AF) may initiate with an irregular rapid burst of atrial ectopic (AE) activity from a pulmonary vein (PV) focus, but how AF is maintained it is not known. The crista terminalis (CT) is an important line of block in atrial flutter (AFL), but its role in AF has not been determined. The aim of this study was to examine the conduction properties of the CT during onset of AF.

METHODS AND RESULTS

In 10 patients (mean age 38 +/- 8 years), we analyzed conduction across the CT during onset of focal AF from an arrhythmogenic PV and during pacing from the same PV at cycle lengths of 700 and 300 ms. A 20-pole catheter was positioned on the CT using intracardiac echocardiography. In 10 control patients with no history of AF, we analyzed conduction across the CT during pacing from the distal coronary sinus at 700 and 300 ms. In all 10 AF patients, AF was initiated with 1 to 9 AE beats (median 5) from a PV. During sinus rhythm, there were no split components (SC) recorded on the CT. During PV AE activity, discrete SC were recorded on the CT in all patients over 6.3 +/- 0.9 bipoles (3.7 +/- 0.3 cm). Maximal splitting of SC was 66 +/- 31 ms (37-139). There was an inverse relationship between AE coupling intervals and the degree of splitting between SC in all patients. Degeneration to AF was preceded by progressive decrement across the CT. SC were recorded during PV pacing at 700 and 300 ms (maximal distance between SC of 24 +/- 3 ms and 43 +/- 5 ms, respectively, P < 0.001). Maximum SC at CT in controls was 13 +/- 8 ms at 700 ms (P = 0.06 vs AF patients) and 16 +/- 9 ms at 300 ms (P < 0.01 vs AF patients).

CONCLUSION

(1) These observations provide evidence of anisotropic, decremental conduction across the CT during onset of focal AF and during pacing from the same PV. A line of functional conduction block develops along this anatomic structure (CT). Whether this line of block acts as an initiator of AF or simply contributes passively to nonuniform fibrillatory conduction is unknown. (2) In some patients with focal AF, development of conduction block along the CT may provide a substrate for typical AFL.

Authors+Show Affiliations

Fynn SP
Royal Melbourne Hospital, Department of Cardiology and Department of Medicine, University of Melbourne, Royal Parade, Parkville, Victoria, Australia.
Morton JB
No affiliation info available
Deen VR
No affiliation info available
Kistler PM
No affiliation info available
Vohra JK
No affiliation info available
Sparks PB
No affiliation info available
Kalman JM
No affiliation info available

MeSH

AdultAtrial FibrillationElectrocardiographyFemaleHeart AtriaHeart Conduction SystemHumansMalePulmonary Veins

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15333074

Citation

Fynn, Simon P., et al. "Conduction Characteristics at the Crista Terminalis During Onset of Pulmonary Vein Atrial Fibrillation." Journal of Cardiovascular Electrophysiology, vol. 15, no. 8, 2004, pp. 855-61.
Fynn SP, Morton JB, Deen VR, et al. Conduction characteristics at the crista terminalis during onset of pulmonary vein atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(8):855-61.
Fynn, S. P., Morton, J. B., Deen, V. R., Kistler, P. M., Vohra, J. K., Sparks, P. B., & Kalman, J. M. (2004). Conduction characteristics at the crista terminalis during onset of pulmonary vein atrial fibrillation. Journal of Cardiovascular Electrophysiology, 15(8), 855-61.
Fynn SP, et al. Conduction Characteristics at the Crista Terminalis During Onset of Pulmonary Vein Atrial Fibrillation. J Cardiovasc Electrophysiol. 2004;15(8):855-61. PubMed PMID: 15333074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conduction characteristics at the crista terminalis during onset of pulmonary vein atrial fibrillation. AU - Fynn,Simon P, AU - Morton,Joseph B, AU - Deen,Vincent R, AU - Kistler,Peter M, AU - Vohra,Jitendra K, AU - Sparks,Paul B, AU - Kalman,Jonathan M, PY - 2004/8/31/pubmed PY - 2004/12/16/medline PY - 2004/8/31/entrez SP - 855 EP - 61 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 15 IS - 8 N2 - INTRODUCTION: Focal atrial fibrillation (AF) may initiate with an irregular rapid burst of atrial ectopic (AE) activity from a pulmonary vein (PV) focus, but how AF is maintained it is not known. The crista terminalis (CT) is an important line of block in atrial flutter (AFL), but its role in AF has not been determined. The aim of this study was to examine the conduction properties of the CT during onset of AF. METHODS AND RESULTS: In 10 patients (mean age 38 +/- 8 years), we analyzed conduction across the CT during onset of focal AF from an arrhythmogenic PV and during pacing from the same PV at cycle lengths of 700 and 300 ms. A 20-pole catheter was positioned on the CT using intracardiac echocardiography. In 10 control patients with no history of AF, we analyzed conduction across the CT during pacing from the distal coronary sinus at 700 and 300 ms. In all 10 AF patients, AF was initiated with 1 to 9 AE beats (median 5) from a PV. During sinus rhythm, there were no split components (SC) recorded on the CT. During PV AE activity, discrete SC were recorded on the CT in all patients over 6.3 +/- 0.9 bipoles (3.7 +/- 0.3 cm). Maximal splitting of SC was 66 +/- 31 ms (37-139). There was an inverse relationship between AE coupling intervals and the degree of splitting between SC in all patients. Degeneration to AF was preceded by progressive decrement across the CT. SC were recorded during PV pacing at 700 and 300 ms (maximal distance between SC of 24 +/- 3 ms and 43 +/- 5 ms, respectively, P < 0.001). Maximum SC at CT in controls was 13 +/- 8 ms at 700 ms (P = 0.06 vs AF patients) and 16 +/- 9 ms at 300 ms (P < 0.01 vs AF patients). CONCLUSION: (1) These observations provide evidence of anisotropic, decremental conduction across the CT during onset of focal AF and during pacing from the same PV. A line of functional conduction block develops along this anatomic structure (CT). Whether this line of block acts as an initiator of AF or simply contributes passively to nonuniform fibrillatory conduction is unknown. (2) In some patients with focal AF, development of conduction block along the CT may provide a substrate for typical AFL. SN - 1045-3873 UR - https://www.unboundmedicine.com/medline/citation/15333074/Conduction_characteristics_at_the_crista_terminalis_during_onset_of_pulmonary_vein_atrial_fibrillation_ DB - PRIME DP - Unbound Medicine ER -