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Organized Activation During Atrial Fibrillation in Man
Author(s) -
ROITHINGER FRANZ X.,
Groenewegen ARNE Sippens,
KARCH MARTIN R.,
STEINER PAUL R.,
ELLIS WILLARD S.,
LESH MICHAEL D.
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb01836.x
Subject(s) - medicine , atrial fibrillation , cardiology , coronary sinus , p wave , fibrillation , sinus rhythm , atrium (architecture) , right atrium , left atrium
Atrial Fibrillation Organization. Introduction: Atrial fibrillation is not entirely random, but little is known about the spatiotemporal endocardial organization and its surface ECG manifestations. Methods and Results: In 16 patients with atrial fibrillation (chronic, n = 14), endocardial mapping of the trabeculated, the posteroseptal smooth right atrium, and the coronary sinus was performed using multipolar catheters. The surface ECG was analyzed by determining “fibrillation wave” (F wave) amplitude, rate, and polarity. During 50 minutes of atrial fibrillation, an organized activation was present 72%± 32% of the analyzed time on the trabeculated, 19%± 15% on the smooth right atrium (P < 0.01), and 51%± 33% along the coronary sinus (P < 0.05). The direction of organized activation was craniocaudal in 72%± 16%. caudocranial in 10%± 9% (P < 0.01), and indeterminable in 18%± 11%. The mean surface F wave amplitude in lead V 1 was 0.128 ± 0.06 mV during 28 seconds of atrial fibrillation with a craniocaudal direction of activation and 0.065 ± 0.02 mV during a disorganized activation (P < 0.01). A stable relation between surface F waves and organized trabeculated right atrial activation was observed, and the mean F wave cycle length (190 ± 27 msec) was highly comparable to the simultaneously measured endocardial cycle length (191 ± 27 msec, correlation coefficient 0.97). F wave polarity in V 1 was positive in 12 of 14 patients during craniocaudal and negative in 11 of 14 patients during caudocranial rigbt atrial free‐wall activation. Conclusion: An organized activation during atrial fibrillation with a predominant craniocaudal direction on the trabeculated right atrium is frequently present and influences the appearance of “coarse” or “fine” atrial fibrillation as well as F wave polarity on the surface ECG.