Spatial and Temporal Periodicity During Atrial Fibrillation

Abstract

HomeCirculationVol. 100, No. 2Spatial and Temporal Periodicity During Atrial Fibrillation Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBSpatial and Temporal Periodicity During Atrial Fibrillation Ivan A. D’Cruz Ivan A. D’CruzIvan A. D’Cruz Director, Echocardiography Labs, VA Medical Center, Memphis and, William F. Bowld Hospital, Professor of Medicine, University of Tennessee, Memphis, Tenn Search for more papers by this author Originally published21 Mar 2018https://doi.org/10.1161/circ.100.2.211/-aCirculation. 1999;100:211–214To the Editor:The article by Skanes et al1 presented interesting evidence of spatial and temporal periodicity during atrial fibrillation, contrary to the traditional concept of totally disorganized random atrial activity in atrial fibrillation. Skanes et al referred to recent work by others23 in accord with their own.With former colleagues in Chicago, Ill, I called attention 20 years ago to the fact that some patients with ECG features of atrial fibrillation have M-mode echocardiographic findings indicating regular atrial contractions. Regular deflections on the mitral valve echogram were demonstrated in Figures 14 and 15 of that paper,4 although the ECG was typical of atrial fibrillation. At the time, we speculated that one explanation for this apparent discrepancy was one dominant circus-motion wave (producing regular atrial contractions), with smaller subsidiary irregular “eddies” of electrical activity responsible for the irregular contour of ECG atrial activity.4 Over the last 2 decades, we have noted that this phenomenon (regular diastolic mitral deflections on echocardiography concomitant with irregular atrial ECG deflections) is not very rare in clinical M-mode recordings, yet few if any similar observations have been published. References 1 Skanes AC, Mandapati R, Berenfeld O, Davidenko JM, Jalife J. Spatiotemporal periodicity during atrial fibrillation in the isolated sheep heart. Circulation.1998; 98:1236–1248.CrossrefMedlineGoogle Scholar2 Gerstenfeld EP, Sahakian AV, Swiryn S. Evidence for transient linking of atrial excitation during atrial fibrillation in humans. Circulation.1992; 86:375–382.CrossrefMedlineGoogle Scholar3 Botteron GW, Smith JM. Quantitative assessment of the spatial organization of atrial fibrillation in the intact human heart. Circulation.1996; 93:513–518.CrossrefMedlineGoogle Scholar4 Prabhu R, D’Cruz I, Cohen H, Glick G. Echocardiographic correlates of atrial contraction in normal and abnormal atrial rhythm. Prog Cardiovasc Dis.1978; 20:463–478.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseMandapati Ravi, Skanes Allan, MD, Berenfeld Omer, PhD, Davidenko Jorge M., MD, and Jalife José, MD13071999We thank Dr D’Cruz for his interest in our article on spatiotemporal periodicity during atrial fibrillation (AF) in the isolated sheep heart.R1 It is reassuring to note that our experimental findings are supported by data from patients suffering from AF. Indeed, review of the manuscript cited by Dr D’CruzR2 reveals in Figures 14 and 15 that excursions of the anterior mitral leaflet (AML) show some degree of regularity. However, careful examination of the figures shows that there is some beat-to-beat change in the frequency of AML excursions. In the same article, the authors do not provide any evidence but speculate that a major or dominant wave front activating the left atrium (LA) could be responsible for the somewhat periodic motion of the AML. This is certainly a possible explanation for their findings. It is, however, important to note that such a suggestion was initially made as early as 1925 by Sir Thomas Lewis, who coined the term “impure flutter.”R3As such, the level of organization during AF may lie on a spectrum depending on the number of sources and the degree of fractionation of the periodic activity into independent wavelets, as well as their subsequent fate. It is quite possible that AF in patients with mitral valve disease is more organized than previously thought, as reported by 2 recent surgical studies.R4R5 In our experimental model, it was rare to find the entire LA being activated in a periodic manner. Usually, only a small part of the LA demonstrated periodic activity. Previous Back to top Next FiguresReferencesRelatedDetails July 13, 1999Vol 100, Issue 2 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/circ.100.2.211/-a Originally publishedMarch 21, 2018 PDF download Advertisement