Role of dispersion of atrial refractoriness in the recurrence of clinical atrial fibrillation. A manifestation of atrial electrical remodelling in humans?

• Published in: European heart journal 2001-10, Vol.22 (19), p.1822-1834
• Main Authors: Fynn, S.P, Todd, D.M, Hobbs, W.J.C, Armstrong, K.L, Garratt, C.J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atrial electrical remodelling; atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; atrial fibrillation cycle length; cardioversion; Chronic Disease; dispersion of atrial refractoriness; Electric Countershock - adverse effects; Electrophysiologic Techniques, Cardiac; Female; Heart Conduction System - physiopathology; Humans; Logistic Models; Male; Middle Aged; Recurrence
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.2001.2607

Aims The mechanism of atrial fibrillation recurrence following cardioversion is unknown, although experimental studies have indicated that changes in dispersion of atrial refractoriness may play a role. The aims of this study were to assess (1) if dispersion of atrial refractoriness is relevant to atrial fibrillation recurrence and (2) if dispersion of refractoriness is part of the atrial electrical remodelling process in humans. Methods and Results Thirty-seven consecutive patients underwent internal cardioversion (CV1) of persistent atrial fibrillation. Patients were monitored by daily transtelephonic recordings following discharge and if there was spontaneous atrial fibrillation recurrence they were rapidly admitted for repeat cardioversion (CV2). We used the 5th percentile of 100 consecutive atrial fibrillation cycle lengths (AFCLP5) and the atrial effective refractory period (AERP) as measures of atrial refractoriness at four different atrial sites. Dispersion of AFCLP5at CV1 was significantly higher in those who had subsequent recurrence of atrial fibrillation than in those who remained in sinus rhythm for at least 1 month after cardioversion (35±17ms vs 9±13ms;P