Abstract
Endo-epicardial asynchrony (EEA) is a new mechanism possibly maintaining atrial fibrillation. We aimed to determine the sensitivity and best recording modus to detect EEA on electrograms recorded from one atrial side using electrogram fractionation. Simultaneously obtained right atrial endo- and epicardial electrograms from 22 patients demonstrating EEA were selected. Unipolar and (converted) bipolar electrograms were analyzed for presence and characteristics of fractionation corresponding to EEA. Sensitivity of presence of EEA corresponding fractionation was high in patients (86–96%) and moderately high (65–78%) for the asynchronous surface area for unipolar and bipolar electrograms equally. In bipolar electrograms, signal-to-noise ratio of EEA corresponding fractionation decreased and additional fractionation increased for electrograms recorded at the endocardium. Sensitivity of fractionation corresponding to EEA is high for both unipolar and bipolar electrograms. Unipolar electrograms are more suited for detection of EEA due to a larger signal-to-noise ratio and less disturbance of additional fractionation.Graphical Unipolar electrograms are more suited than bipolar electrograms to detect endo-epicardial asynchrony on one side of the atrial wall using electrogram fractionation.
Highlights
The electrical pathophysiological mechanisms of persistent atrial fibrillation remain to this day largely unknown
Recent evidence suggests that dissociated electrical conduction between the layers of the atrial wall presenting as endoepicardial asynchrony (EEA) in excitation is a potential significant mechanism for persistence of atrial fibrillation [1, 2]
After canine and goat models, a new simultaneous endo-epicardial mapping approach allowed for documentation of EEA of the right atrial wall in Associate Editor Sunil Kapur oversaw the review of this article
Summary
The electrical pathophysiological mechanisms of persistent atrial fibrillation remain to this day largely unknown. Recent evidence suggests that dissociated electrical conduction between the layers of the atrial wall presenting as endoepicardial asynchrony (EEA) in excitation is a potential significant mechanism for persistence of atrial fibrillation [1, 2]. The asynchronous activation of epicardial and endocardial layers provides opportunity for waves of excitation to travel transmurally and cause new breakthrough waves on the opposite side of the wall. After canine and goat models, a new simultaneous endo-epicardial mapping approach allowed for documentation of EEA of the right atrial wall in Associate Editor Sunil Kapur oversaw the review of this article.
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