Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease

• Published in: Journal of interventional cardiac electrophysiology 2013-11, Vol.38 (2), p.85-93
• Main Authors: van Brakel, Thomas J., van der Krieken, Thomas, Westra, Sjoerd W., van der Laak, Jeroen A., Smeets, Joep L., van Swieten, Henry A.
• Format: Article
• Language: English
• Subjects: Aged; Atrial Appendage - pathology; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Cardiology; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Electrocardiography - methods; Fibrosis; Heart Valve Diseases - complications; Heart Valve Diseases - diagnosis; Heart Valve Diseases - surgery; Humans; Medicine; Medicine & Public Health; Middle Aged; Reproducibility of Results; Sensitivity and Specificity
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-013-9820-8

Purpose This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for potential ablation therapy. Methods Interstitial fibrosis from right (RAA) and/or left atrial appendages (LAA) was studied in patients with sinus rhythm (SR, n  = 8), paroxysmal ( n  = 21), and persistent AF ( n  = 20) undergoing coronary artery bypass and/or aortic or mitral valve surgery. Atrial fibrosis quantification was performed with Masson trichrome staining. Intraoperative bipolar epicardial electrophysiological measurements were performed to correlate fibrosis to electrogram fractionation, voltage, and AF cycle length. Results The average degree of fibrosis was 11.2 ± 7.2 % in the LAA and 22.8 ± 7.6 % in the RAA ( p