Arrhythmias & electrophysiologyMechanistic study
Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation
- Mechanistic study
- intra-operative high-resolution epicardial mapping
Authors' conclusion
Unipolar EGM characteristics during spontaneous AES are mainly directional-dependent and not rate-dependent. AF patients have more direction-dependent conduction disorders, indicating enhanced non-uniform anisotropy that is uncovered by spontaneous AES.
Study context
- Population
- Patients undergoing intra-operative epicardial mapping of the right and left atrium, Bachmann's Bundle and pulmonary vein area60 with atrial fibrillation (AF)
- Participants
- 287 patients
- Comparison
- Spontaneous atrial extrasystoles (AES) vs sinus rhythm (SR)
- Outcome
- Impact of spontaneous AES on potential amplitude, fractionation, duration and low-voltage areas (LVAs), correlated with prematurity and aberrancy
Main finding
As reported in the abstract
AES vs SRDifference, mV (CI)P value
average voltage, all atrial regions
−1.1(−1.2 to −0.9)
P < 0.001- amount of low-voltage areas (LVAs)
- difference +3.4 % (CI 2.7–4.1); P < 0.001
- fractionation
- difference +3.2 % (CI 2.6–3.7); P < 0.001
Further findings
Correlation of electrogram (EGM) morphology parameters with prematurity indices
- Only weak or moderate correlations
- R2 < 0.299, P < 0.001
Effect by degree of aberrancy
- All parameters most severely affected by mild/opposite or severely aberrant AES; effect more pronounced in AF patients
Regional differences
- Considerable regional differences in effects provoked by AES
AES characteristics
- Premature AES
- 457
- Mild/opposite aberrant AES
- 58
- Moderate aberrant AES
- 355
- Severe aberrant AES
- 154
- Average prematurity index
- 28% [12-45]
Original publication
Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation. Europace. Published 21 July 2023. doi:10.1093/europace/euad223
Summarised from the published abstract; every number is checked against it