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Biatrial Substrate Properties in Patients with Atrial Fibrillation

Authors

  • SHIH-LIN CHANG M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
    2. Division of Cardiovascular Medicine, Suao Veterans Hospital, Taiwan
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  • CHING-TAI TAI M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • YENN-JIANG LIN M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • WANWARANG WONGCHAROEN M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • LI-WEI LO M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • TA-CHUAN TUAN M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • AMEYA R. UDYAVAR M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • SHENG-HSIUNG CHANG M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • HSUAN-MING TSAO M.D.,

    1. Division of Cardiovascular Medicine, I-Lan Hospital, Taiwan
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  • MING-HSIUNG HSIEH M.D.,

    1. Division of Cardiovascular Medicine, Taipei Medical University, Wan-Fang Hospital, Taiwan
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  • YU-FENG HU M.D.,

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • YI-JEN CHEN M.D., Ph.D,

    1. Division of Cardiovascular Medicine, Taipei Medical University, Wan-Fang Hospital, Taiwan
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  • SHIH-ANN CHEN M.D.

    1. Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taiwan
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  • Manuscript received 2 March 2007; Revised manuscript received 26 June 2007; Accepted for publication 9 July 2007.

Address for correspondence: Shih-Ann Chen, M.D., Division of Cardiology, Veterans General Hospital-Taipei, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan. Fax: 886-2-2873-5656; E-Mail: epsachen@ms41.hinet.net

Abstract

Introduction: The atrial substrate plays an important role in the maintenance of atrial fibrillation (AF). Further investigation of the biatrial substrate may be helpful for understanding the mechanism of AF. The aim of this study was to investigate the properties of right and left atrial (RA and LA) substrate in AF patients and their impact on the catheter ablation.

Methods: Biatrial electroanatomic mapping using a three-dimensional mapping system (NavX) was performed in 117 consecutive patients with paroxysmal (n = 99) and persistent (n = 18) AF. The biatrial voltage and total activation time (TAT) were obtained during sinus rhythm.

Results: The LA had a lower voltage (1.6 ± 0.5 vs 2.0 ± 0.6 mV, P < 0.001) than the RA. The TAT correlated with the voltage (r =–0.65, P< 0.001). The patients with persistent AF had a lower atrial voltage, higher coefficient of variance for the LA voltage, longer LA TAT, and more extensive scar than those with paroxysmal. The patients with recurrent AF after catheter ablation had a lower LA voltage and higher incidence of LA scarring than those without recurrence. A scar located in the low anteroseptal or low posterior wall of LA was related to recurrence of AF. LA scarring was the independent predictor of AF recurrence after catheter ablation.

Conclusion: The LA voltage was lower than the RA, and the atrial voltage correlated with the TAT. Electroanatomical remodeling of the atria could be crucial to the maintenance of AF. The LA substrate properties may play an important role in the recurrence of AF after catheter ablation of AF.

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