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Autonomic modulation impacts conduction velocity dynamics and wavefront propagation in the left atrium.
Honarbakhsh, Shohreh; Roney, Caroline; Horrach, Caterina Vidal; Lambiase, Pier D; Hunter, Ross J.
Afiliación
  • Honarbakhsh S; Queen Mary University of London, London, UK.
  • Roney C; Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Horrach CV; Queen Mary University of London, London, UK.
  • Lambiase PD; Queen Mary University of London, London, UK.
  • Hunter RJ; Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
Europace ; 26(9)2024 Aug 30.
Article en En | MEDLINE | ID: mdl-39230049
ABSTRACT

AIMS:

Atrial fibrosis and autonomic remodelling are proposed pathophysiological mechanisms in atrial fibrillation (AF). Their impact on conduction velocity (CV) dynamics and wavefront propagation was evaluated. METHODS AND

RESULTS:

Local activation times (LATs), voltage, and geometry data were obtained from patients undergoing ablation for persistent AF. LATs were obtained at three pacing intervals (PIs) in sinus rhythm (SR). LATs were used to determine CV dynamics and their relationship to local voltage amplitude. The impact of autonomic modulation- pharmacologically and with ganglionated plexi (GP) stimulation, on CV dynamics, wavefront propagation, and pivot points (change in wavefront propagation of ≥90°) was determined in SR. Fifty-four patients were included. Voltage impacted CV dynamics whereby at non-low voltage zones (LVZs) (≥0.5 mV) the CV restitution curves are steeper [0.03 ± 0.03 m/s ΔCV PI 600-400 ms (PI1), 0.54 ± 0.09 m/s ΔCV PI 400-250 ms (PI2)], broader at LVZ (0.2-0.49 mV) (0.17 ± 0.09 m/s ΔCV PI1, 0.25 ± 0.11 m/s ΔCV PI2), and flat at very LVZ (<0.2 mV) (0.03 ± 0.01 m/s ΔCV PI1, 0.04 ± 0.02 m/s ΔCV PI2). Atropine did not change CV dynamics, while isoprenaline and GP stimulation resulted in greater CV slowing with rate. Isoprenaline (2.7 ± 1.1 increase/patient) and GP stimulation (2.8 ± 1.3 increase/patient) promoted CV heterogeneity, i.e. rate-dependent CV (RDCV) slowing sites. Most pivot points co-located to RDCV slowing sites (80.2%). Isoprenaline (1.3 ± 1.1 pivot increase/patient) and GP stimulation (1.5 ± 1.1 increase/patient) also enhanced the number of pivot points identified.

CONCLUSION:

Atrial CV dynamics is affected by fibrosis burden and influenced by autonomic modulation which enhances CV heterogeneity and distribution of pivot points. This study provides further insight into the impact of autonomic remodelling in AF.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Fibrosis / Atrios Cardíacos Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Fibrosis / Atrios Cardíacos Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido