Provocation and localization of atrial ectopy in patients with atrial septal defects

Background Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoke...

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Published in:Journal of interventional cardiac electrophysiology 2022-10, Vol.65 (1), p.227-237
Main Authors: O’Neill, Louisa, Sim, Iain, O’Hare, Daniel, Whitaker, John, Mukherjee, Rahul K., Niederer, Steven, Wright, Matthew, Ezzat, Vivienne, Rosenthal, Eric, Jones, Matthew I., Frigiola, Alessandra, O’Neill, Mark D., Williams, Steven E.
Format: Article
Language:English
Subjects:
Ablation
Arrhythmia
Calibration
Cardiac arrhythmia
Cardiology
Cardiovascular disease
Cardiovascular diseases
Catheters
Congenital diseases
Coronary artery disease
Defects
Electrocardiography
Electrophysiology
Heart
Heart diseases
Localization
Medicine
Medicine & Public Health
P waves
Veins & arteries
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Summary:Background Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P  = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-022-01273-2