A comparison of the electrophysiologic and electroanatomic characteristics between the right and left atrium in persistent atrial fibrillation: Is the right atrium a window into the left?

Abstract

The right atrium (RA) is readily accessible; however, it is unclear whether changes in the RA are representative of the LA. We performed detailed biatrial electroanatomic mapping to determine the electrophysiological relationship between the atria. Consecutive patients with persistent AF underwent biatrial electroanatomical mapping with a contact force catheter acquiring points with a CF>10g prior to ablation. Points were analyzed for tissue voltage, complex electrograms, low voltage (<0.5mV), scar (<0.05mV), and conduction velocity (CV). Forty patients (mean age 59 ± 9.2 years, AF duration 12.9 ± 9.2 months, LA area: 28 ± 5.2, RA area: 25 ± 6.4mm2 , LVEF: 44 ± 15%) underwent mapping during CS pacing. Bipolar voltage (R=0.57, P<0.001), unipolar voltage (R=0.68, P<0.001), low voltage (<0.5 nV) (R=0.48, P=0.002), fractionation (R=0.73, P<0.001), and CV (R=0.49, P=0.001) correlated well between atria. There was no difference in global bipolar voltage (LA 1.89 ± 0.77vs. RA 1.77 ± 0.57mV, P=0.57); complex electrograms (LA 20%vs. RA 20%, P=0.99) or low voltage (LA 15%vs. RA 16%, P=0.84). Global unipolar voltage was significantly higher in the LA compared to the RA (2.95 ± 1.14vs. 2.28 ± 0.65mV, P=0.002) and CV was significantly slower in the RA compared to the LA (0.93 ± 0.15m/svs. 1.01 ± 0.19m/s, P=0.001). AF is associated with remodeling processes affecting both atria. The more accessible RA provides an insight into the biatrial process associated with AF in various disease states without trans-septal access.