Relation of pulmonary venous fibrillatory rates to rates obtained from the surface electrocardiogram in persistent atrial fibrillation

Abstract

Dominant atrial rates obtained from the sugace electrocardiogram (ECG) during atrial fibrillation (AF) have been shown to reflect right atrial (RA) and coronary sinus (CS} rates. The relation of pulmonary venous (PV) fibrillatory rate to rates obtained from she standard 12- lead surfuce ECG, is, however, not known. Baseline IO-second 12-lead ECG recordings were made in 25 consecutive patients undergoing PV isolation for AF. After spatiotemporal QRST cancellation, Fourierbased time-frequency analysis was pelformed and atrial fibrillatory rate was determined. Mean PV fibrillatory rates were slightly higher than RA and CS rates, with no difference between right and left PVs. RA {R=.865, p<.OOI), CS (R=.558, p=.025) and PV rates (R=.457, p=.033) were related with rates obtained from lead VI. There was a positive correlation between AF duration and RA (R=.545, p<.05), CS (R=.530, p<.05) and subsequently VI rates (R=. 704, p=.U07), but not between AF duration and PV rates (R=.087,p =ns). This resulted in a negative correlation (R=-.533, p<.05) between PV - VI rate di&rences and AF duration. In conclusion, fibrillatory rates obtained from surface ECG lead VI reflect RA, CS and to a ksser degree PV rates. As AF progresses, RA, CS and subsequently VI rates increase, while the PV - VI rate diference decreases indicating a more important role of other atrial parts for AF persistence. Fibrillatory rates from lead VI seem to express overall electrical remodeling in persistent AF.