Right-to-left frequency gradient during atrial fibrillation initiated by right atrial ectopies and its augmentation by adenosine triphosphate: Implications of right atrial fibrillation

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• 作者：Hideyuki Hasebe ; MD^* ; Kentaro Yoshida ; MD^&dagger ; ; ^&Dagger ; ; ^{kentaroyo@nifty.com" class="auth_mail" title="E-mail the corresponding author} ; Masataka Iida ; B.Eng^§ ; ; Naoki Hatano ; B.Eng^§ ; ; Toshiro Muramatsu ; B.Eng^§ ; ; Kazutaka Aonuma ; MD^&Dagger ;
• 关键词：AF ; atrial fibrillation ; AF-RAE ; atrial fibrillation initiated by right atrial ectopy ; ATP ; adenosine triphosphate ; CS ; coronary sinus ; DF ; dominant frequency ; HRA ; high right atrium ; LA ; left atrium/atrial ; L-PVA ; left pulmonary vein antrum ; PV ; pulmonary vein ; PV-LAJ ; pulmonary vein-left atrial junction ; RA ; right atrium/atrial ; R-PVA ; right pulmonary vein antrum ; SVC ; superior vena cava
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：354-363
• 全文大小：2496 K

文摘

A left-to-right dominant frequency (DF) gradient commonly exists in paroxysmal atrial fibrillation (AF). AF initiated by right atrial (RA) ectopy (AF-RAE) is rare.

Objective

This study aimed to investigate characteristics of AF-RAE using pharmacological maneuvers and spectral analysis.

Methods

Seventy-nine consecutive patients referred for catheter ablation of paroxysmal AF were enrolled. Infusions of isoproterenol and adenosine triphosphate (ATP) were used to induce AF. Patients with AF-RAE and patients with AF initiated only by pulmonary vein (PV) ectopies were classified into the RA-ectopy group (n = 7[9%]) and PV-ectopy group (n = 32[41%]), respectively. ATP was also injected during ongoing AF to unmask the driver of AF. High RA, coronary sinus, and PV-left atrial junction electrograms and electrocardiogram lead V₁ underwent spectral analyses.

Results

Patients in the RA-ectopy group were younger (51 ± 13 years vs 63 ± 7 years; P = .01) and more commonly had a family history of AF (71% vs 9%; P < .001) than patients in the PV-ectopy group. There was a baseline right-to-left DF gradient in the RA-ectopy group (PV-left atrial junction: 6.0 ± 0.4 Hz; coronary sinus: 5.7 ± 0.6 Hz; RA: 7.3 ± 0.8 Hz; P < .05) in contrast to a left-to-right DF gradient in the PV-ectopy group (5.9 ± 0.8, 5.3 ± 0.7, 5.2 ± 0.8 Hz; P < .01). ATP injection predominantly increased the DF of the high RA in the RA-ectopy group and augmented a right-to-left DF gradient (7.9 ± 1.8, 7.6 ± 1.0, 10.7 ± 0.7 Hz; P < .001), whereas it augmented a left-to-right DF gradient in the PV-ectopy group (7.9 ± 1.0, 6.4 ± 0.5, 6.6 ± 1.2 Hz; P < .05).

Conclusion

A rare type of paroxysmal AF initiated by RA ectopy may be maintained by a reentrant driver localized in the RA (so-called RA fibrillation).