Abstract
Different arrhythmogenic substrates for atrial fibrillation (AF) may underlie aortic valve (AV) and mitral valve (MV) disease. We located conduction disorders during sinus rhythm by high-resolution epicardial mapping in patients undergoing AV (n = 85) or MV (n = 54) surgery. Extent and distribution of conduction delay (CD) and block (CD) across the entire right and left atrial surface was determined from circa 1880 unipolar electrogram recordings per patient. CD and CB were most pronounced at the superior intercaval area (2.5% of surface, maximal degree 6.6%/cm2). MV patients had a higher maximal degree of CD at the lateral left atrium than AV patients (4.2 vs 2.3%/cm2, p = 0.001). A history of AF was most strongly correlated to CD/CB at Bachmann’s bundle and age. Although MV patients have more conduction disorders at the lateral left atrium, disturbed conduction at Bachmann’s bundle during sinus rhythm indicates the presence of atrial remodeling which is related to AF episodes.
Highlights
Valvular heart disease predisposes to the occurrence of atrial tachyarrhythmias
We aim to determine if predilection sites of conduction disorders during sinus rhythm exist in patients with valvular heart disease who have
Epicardial high-resolution mapping during sinus rhythm was performed in 139 patients who underwent cardiac surgery for valvular heart disease
Summary
Valvular heart disease predisposes to the occurrence of atrial tachyarrhythmias. It has been previously demonstrated that structural remodeling and not electrical remodeling is the major contributor to development of AF in models of chronic atrial stretch [3]. The electrophysiological disturbances due to structural alterations in patients with valvular heart disease may be identifiable during sinus rhythm. The purpose of this study is first to identify differences in the amount and distribution of highresolution conduction disorders during sinus rhythm between patients with AV and MV disease. We aim to determine if predilection sites of conduction disorders during sinus rhythm exist in patients with valvular heart disease who have. A high-resolution epicardial mapping approach was performed to locate atrial areas with conduction abnormalities and identify the differences in conduction disorders between patients with AV and MV disease requiring surgical treatment
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