Anatomically Determined Functional Conduction Delay in the Posterior Left Atrium: Relationship to Structural Heart Disease

Abstract

Objectives This study sought to characterize the conduction properties of the posterior left atrium (PLA) in patients with different forms of structural heart disease undergoing cardiac surgery. Background The PLA plays an important role in the initiation and maintenance of atrial fibrillation. Methods This study included 34 patients having elective cardiac surgery. There were 4 groups of patients: normal left ventricular (LV) function (coronary artery bypass grafting [CABG]); severe LV dysfunction (LVF/CABG); severe mitral regurgitation (MR); severe aortic stenosis (AS). Epicardial mapping of the PLA was performed in sinus rhythm and during differential pacing. Activation patterns, regional conduction velocity (CV), conduction heterogeneity, anisotropy, and total plaque activation time (TAT) were assessed. Results Left atrial size in patients with LVF/CABG (47 ± 7 mm) and MR (54 ± 6 mm) was larger than patients with CABG (39 ± 7 mm) and AS (42 ± 6 mm; p Conclusions There is a line of functional conduction delay in a consistent anatomical location in the PLA in patients with structural heart disease. This is most marked in conditions associated with significant chronic atrial enlargement and leads to circuitous wave front propagation, suggesting a potential role in arrhythmogenesis.