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

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

EP Europace ◽

10.1093/europace/euaa162.291 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

R Kharbanda ◽

P Knops ◽

J M E Van Der Does ◽

C Kik ◽

Y J H J Taverne ◽

...

Keyword(s):

Right Atrium ◽

Conduction Block ◽

Epicardial Mapping ◽

Human Right ◽

3 Dimensional ◽

Conduction Disorders ◽

Human Right Atrium ◽

History Of ◽

Longitudinal Dissociation ◽

Funding Acknowledgements

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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Atrial Ectopy Increases Asynchronous Activation of the Endo- and Epicardium at the Right Atrium

Journal of Clinical Medicine ◽

10.3390/jcm9020558 ◽

2020 ◽

Vol 9 (2) ◽

pp. 558

Author(s):

Lisette J.M.E. van der Does ◽

Rohit K. Kharbanda ◽

Christophe P. Teuwen ◽

Paul Knops ◽

Charles Kik ◽

...

Keyword(s):

Sinus Rhythm ◽

Right Atrium ◽

Conduction Block ◽

Conduction Delay ◽

Electrode Arrays ◽

Conduction Disturbances ◽

Conduction Disorders ◽

The Difference ◽

Endocardial Layer ◽

The Right

The predisposition of atrial extrasystoles (AES) to trigger cardiac tachyarrhythmia may arise from intramural conduction disorders causing endo-epicardial asynchrony (EEA). This study aimed to determine whether spontaneous AES disturb endo-epicardial conduction. Simultaneous endo-epicardial mapping of the right atrium was performed in patients during cardiac surgery with two 128-electrode arrays. Sixty spontaneous AES were observed in 23 patients and were analyzed for incidence of conduction delay, conduction block and amount of EEA compared to the previous sinus rhythm beat. Both conduction delay and block occurred more often in AES compared to sinus rhythm. The difference in lines of conduction block between the epicardium and endocardium increased in AES causing a greater imbalance of conduction disorders between the layers. The incidence of EEA with differences ≥10 ms increased significantly in AES. AES caused delays between the epicardium and endocardium up to 130 ms and EEA to increase for up to half (47%) of the mapping area. Conduction disturbances between the epicardial and endocardial layer giving rise to EEA increase during AES. Asynchronous activation of the atrial layers increases during AES which may be a mechanism for triggering cardiac tachyarrhythmia under the right conditions but EEA cannot be recognized by current mapping tools.

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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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The Effects of Valvular Heart Disease on Atrial Conduction During Sinus Rhythm

Journal of Cardiovascular Translational Research ◽

10.1007/s12265-019-09936-8 ◽

2019 ◽

Vol 13 (4) ◽

pp. 632-639 ◽

Cited By ~ 1

Author(s):

Lisette J. M. E. van der Does ◽

Eva A. H. Lanters ◽

Christophe P. Teuwen ◽

Elisabeth M. J. P. Mouws ◽

Ameeta Yaksh ◽

...

Keyword(s):

Sinus Rhythm ◽

Left Atrium ◽

Conduction Delay ◽

Atrial Remodeling ◽

Strongly Correlated ◽

Maximal Degree ◽

Conduction Disorders ◽

History Of ◽

Bachmann’S Bundle ◽

Unipolar Electrogram

AbstractDifferent arrhythmogenic substrates for atrial fibrillation (AF) may underlie aortic valve (AV) and mitral valve (MV) disease. We located conduction disorders during sinus rhythm by high-resolution epicardial mapping in patients undergoing AV (n = 85) or MV (n = 54) surgery. Extent and distribution of conduction delay (CD) and block (CD) across the entire right and left atrial surface was determined from circa 1880 unipolar electrogram recordings per patient. CD and CB were most pronounced at the superior intercaval area (2.5% of surface, maximal degree 6.6%/cm2). MV patients had a higher maximal degree of CD at the lateral left atrium than AV patients (4.2 vs 2.3%/cm2, p = 0.001). A history of AF was most strongly correlated to CD/CB at Bachmann’s bundle and age. Although MV patients have more conduction disorders at the lateral left atrium, disturbed conduction at Bachmann’s bundle during sinus rhythm indicates the presence of atrial remodeling which is related to AF episodes.

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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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