P380Simultaneous endo-epicardial mapping of the human right atrium: unravelling 3-dimensional excitation

Abstract Funding Acknowledgements Prof. Dr. NMS de Groot is supported by funding grants from CVON-AFFIP (914728), NWO-Vidi (91717339), Biosense Webster USA (ICD 783454) and Medical Del Abstract Introduction & Purpose Mapping studies demonstrated that endo-epicardial asynchrony (EEA) and conduction disorders, mainly longitudinal dissociation, play an important role in the pathophysiology of atrial fibrillation (AF). The aim of our study was therefore to investigate the correlation between features of conduction disorders assessed in the endo- and epicardial plane and the degree of EEA. Methods In 80 patients (63 male (79%), age 66 ± 9 years, 31 history of AF (39%)) undergoing cardiac surgery, simultaneous endo-epicardial mapping (256 electrodes, interelectrode distance:2mm) of the inferior, middle and superior right atrium (RA) was performed during SR. Areas of conduction block (CB) were defined as conduction delays of ≥12ms, EEA as activation time differences of opposite electrodes of ≥15ms and transmural CB as CB at similar endo-epicardial sites. Results Amount of CB was highest at the endocardium (endo median:1.9% [0-21.6] vs. epi median:1.1% [0-19.2], all locations p < 0.025) and was more pronounced at the superior RA. Amount of conduction block at both the endo-epicardium combined was higher at the superior RA in patients with hypertension (p = 0.046). Likewise, prevalence of transmural CB and EEA,-up to 84ms-, significantly increased from inferior to superior RA (all p < 0.001). Transmural CB at the inferior RA appeared to be associated with a higher incidence of post-operative AF (p = 0.03). Degree of EEA was also highest at superior RA (superior: 17.5ms [16-21.75] vs mid: 17ms [0-20] and inferior: 0ms [0-17], p < 0.001). Prevalence of CB was correlated with prevalence EEA (r= 0.74-0.87; all locations p < 0.001). In patients with hypertension (p = 0.009), diabetes (p = 0.015) and hypercholesterolemia (p = 0.015), EEA degree was higher at inferior RA. Significantly more CB (p = 0.007) and EEA (p = 0.037) were observed in patients with a history of persistent AF compared to patients without AF history. Conclusions This study provides important insights into the complex 3-dimensional endo-epicardial excitation and arrhythmogenesis. Knowledge of 3-dimensional excitation during SR is essential to understand the substrate underlying AF in order to improve (ablative) AF therapy.

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Simultaneous Endo‐Epicardial Mapping of the Human Right Atrium: Unraveling Atrial Excitation

Journal of the American Heart Association ◽

10.1161/jaha.120.017069 ◽

2020 ◽

Vol 9 (17) ◽

Author(s):

Rohit K. Kharbanda ◽

Paul Knops ◽

Lisette J. M. E. van der Does ◽

Charles Kik ◽

Yannick J. H. J. Taverne ◽

...

Keyword(s):

Sinus Rhythm ◽

Right Atrium ◽

Conduction Block ◽

Significant Degree ◽

Interquartile Range ◽

Human Right ◽

3 Dimensional ◽

Conduction Disorders ◽

Human Right Atrium ◽

History Of

Background The significance of endo‐epicardial asynchrony (EEA) and atrial conduction block (CB), which play an important role in the pathophysiology of atrial fibrillation (AF) during sinus rhythm is poorly understood. The aim of our study was therefore to examine 3‐dimensional activation of the human right atrium (RA). Methods and Results Eighty patients (79% men, 39% history of AF) underwent simultaneous endo‐epicardial sinus rhythm mapping of the inferior, middle and superior RA. Areas of CB were defined as conduction delays of ≥12 ms, EEA as activation time differences of opposite electrodes of ≥15 ms and transmural CB as CB at similar endo‐epicardial sites. CB was more pronounced at the endocardium (all locations P <0.025). Amount, extensiveness and severity of CB was higher at the superior RA. Transmural CB at the inferior RA was associated with a higher incidence of post‐operative AF ( P =0.03). EEA occurred up to 84 ms and was more pronounced at the superior RA (superior: 27 ms [interquartile range, 18.3–39.3], versus mid‐RA: 20.3 ms [interquartile range, 0–29.9], and inferior RA: 0 ms [interquartile range, 0–21], P <0.001). Hypertension ( P =0.009), diabetes mellitus ( P =0.018), and hypercholesterolemia ( P =0.015) were associated with a higher degree of EEA. CB ( P =0.007) and EEA ( P =0.037) were more pronounced in patients with a history of persistent AF compared with patients without AF history. Conclusions This study provides important insights into complex atrial endo‐epicardial excitation. Significant differences in conduction disorders between the endo‐ and epicardium and a significant degree of EEA are already present during sinus rhythm and are more pronounced in patients with cardiovascular risk factors or a history of persistent AF.

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Simultaneous endo-epicardial mapping of programmed atrial extrasystoles in patients undergoing cardiac surgery

European Heart Journal ◽

10.1093/ehjci/ehaa946.0462 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Kharbanda ◽

M.S Van Schie ◽

Y.J.H.J Taverne ◽

C Kik ◽

F.R.N Van Schaagen ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Conduction Block ◽

Epicardial Mapping ◽

Atrial Wall ◽

3 Dimensional ◽

Conduction Disorders ◽

Post Operative Atrial Fibrillation ◽

Arrhythmogenic Effect ◽

The Right

Abstract Introduction Atrial extrasystoles (AES) are usually innocent, however they can also trigger (post-operative) atrial fibrillation (AF). It is unknown what the arrhythmogenic effect of AES is on 3-dimensional atrial conduction. Purpose Therefore, the aim of this study was to examine the effect of programmed AES (PAES) provoked in the right atrium (RA) on both endo- and epicardial conduction. Methods Simultaneous endo-epicardial mapping of the RA was performed during PAES provoked from the RA free wall in patients undergoing cardiac surgery (256 electrodes). Areas of conduction block (CB) were defined as conduction delays of ≥12ms and endo-epicardial asynchrony (EEA) as activation time differences of exact opposite electrodes of ≥15ms. Results Simultaneous endo-epicardial mapping of the RA during 15 PAES were analyzed and compared with sinus rhythm (SR) (n=12, 58% male, age 68±7 years). Eleven PAES were premature (>25% shortening cycle length (CL)), median preceding CL was 554.5ms [377.9–720.4] and median SR CL was 871ms [700.9–1021]. Amount of EEA (7.3% [2.6–17.8] vs 1% [1–2], p=0.002) and CB (9% [4.8–11.8] vs 1.4% [0.5–2.7, p=0.001) both increased during PAES compared to SR. Diabetes was the only cardiovascular risk factor associated with a higher incidence and degree of EEA and CB. Interestingly, CB during PAES was more severe in 4 patients (33.3%) who developed post-operative AF (11.9% [10.4–12.8] vs 5.4% [3.3–8.5], p<0.001). Conclusion Asynchronous activation of the atrial wall and conduction disorders, which play an important role in arrhythmogenesis, are enhanced during PAES compared to SR. Enhanced electropathology together with triggers provoked by heart surgery may initiate post-operative AF. Funding Acknowledgement Type of funding source: None

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A 5-HT4-like receptor in human right atrium

Naunyn-Schmiedeberg s Archives of Pharmacology ◽

10.1007/bf00167212 ◽

1991 ◽

Vol 344 (2) ◽

pp. 150-159 ◽

Cited By ~ 78

Author(s):

Alberto J. Kaumann ◽

Louise Sanders ◽

Anthony M. Brown ◽

Kenneth J. Murray ◽

Morris J. Brown

Keyword(s):

Right Atrium ◽

Human Right ◽

Human Right Atrium

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Urotensin II receptor expression in human right atrium and aorta: effects of ischaemic heart disease

British Journal of Anaesthesia ◽

10.1093/bja/aep011 ◽

2009 ◽

Vol 102 (4) ◽

pp. 477-484 ◽

Cited By ~ 5

Author(s):

A.D. Leonard ◽

J.P. Thompson ◽

E.L. Hutchinson ◽

S.P. Young ◽

J. McDonald ◽

...

Keyword(s):

Heart Disease ◽

Ischaemic Heart Disease ◽

Right Atrium ◽

Receptor Expression ◽

Urotensin Ii ◽

Human Right ◽

Human Right Atrium

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The repolarization-excitability relationship in the human right atrium is unaffected by cycle length, recording site and prior arrhythmias

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(00)01189-x ◽

2001 ◽

Vol 37 (3) ◽

pp. 920-925 ◽

Cited By ~ 30

Author(s):

Frank Bode ◽

Michael Kilborn ◽

Pamela Karasik ◽

Michael R Franz

Keyword(s):

Right Atrium ◽

Cycle Length ◽

Recording Site ◽

Human Right ◽

Human Right Atrium

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From cellular automata model of vagal control of the human right atrium to heart beats patterns

Physica D Nonlinear Phenomena ◽

10.1016/j.physd.2020.132771 ◽

2021 ◽

Vol 415 ◽

pp. 132771

Author(s):

Danuta Makowiec ◽

Wiesław Miklaszewski ◽

Joanna Wdowczyk ◽

Anna T. Lawniczak

Keyword(s):

Cellular Automata ◽

Right Atrium ◽

Human Right ◽

Cellular Automata Model ◽

Vagal Control ◽

Human Right Atrium

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Prostacyclins have no direct inotropic effect on isolated atrial strips from the normal and pressure-overloaded human right heart

Pulmonary Circulation ◽

10.1177/2045893217691532 ◽

2017 ◽

Vol 7 (2) ◽

pp. 339-347 ◽

Cited By ~ 5

Author(s):

Sarah Holmboe ◽

Asger Andersen ◽

Rebekka V. Jensen ◽

Hans Henrik Kimose ◽

Lars B. Ilkjær ◽

...

Keyword(s):

Right Atrium ◽

Quantitative Polymerase Chain Reaction ◽

Organ Bath ◽

Inotropic Response ◽

Force Of Contraction ◽

Human Right ◽

Prostanoid Receptors ◽

Right Heart ◽

Inotropic Effects ◽

Human Right Atrium

Prostacyclins are vasodilatory agents used in the treatment of pulmonary arterial hypertension. The direct effects of prostacyclins on right heart function are still not clarified. The aim of this study was to investigate the possible direct inotropic properties of clinical available prostacyclin mimetics in the normal and the pressure-overloaded human right atrium. Trabeculae from the right atrium were collected during surgery from chronic thromboembolic pulmonary hypertension (CTEPH) patients with pressure-overloaded right hearts, undergoing pulmonary thromboendarterectomy (n = 10) and from patients with normal right hearts operated by valve replacement or coronary bypass surgery (n = 9). The trabeculae were placed in an organ bath, continuously paced at 1 Hz. They were subjected to increasing concentrations of iloprost, treprostinil, epoprostenol, or MRE-269, followed by isoprenaline to elicit a reference inotropic response. The force of contraction was measured continuously. The expression of prostanoid receptors was explored through quantitative polymerase chain reaction (qPCR). Iloprost, treprostinil, epoprostenol, or MRE-269 did not alter force of contraction in any of the trabeculae. Isoprenaline showed a direct inotropic response in both trabeculae from the pressure-overloaded right atrium and from the normal right atrium. Control experiments on ventricular trabeculae from the pig failed to show an inotropic response to the prostacyclin mimetics. qPCR demonstrated varying expression of the different prostanoid receptors in the human atrium. In conclusion, prostacyclin mimetics did not increase the force of contraction of human atrial trabeculae from the normal or the pressure-overloaded right heart. These data suggest that prostacyclin mimetics have no direct inotropic effects in the human right atrium.

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