Mean atrial fibrillation intervals strongly correlated with atrial functional refractory period (r=0.73, P<0.001), and self-termination was associated with significant mean interval prolongation.
Observational (n=25)
Does high-voltage burst pacing alter local atrial activity during paroxysmal atrial fibrillation in patients with lone paroxysmal AF?
The self-termination of atrial fibrillation is related to a prolongation of functional refractoriness, whereas persistence is associated with shortening of refractoriness, and burst pacing demonstrates an excitability gap.
Effect estimate: r=0.73
p-value: p=<0.001
Background The aims of our study were to investigate the meaning of local atrial activation and its behavior during paroxysmal atrial fibrillation and to study the effect of overdrive pacing on local atrial activity. Methods and Results Twenty-five patients with lone paroxysmal atrial fibrillation underwent electrophysiological study. Functional and effective atrial refractoriness was determined. Mean and fifth percentile values of 100 consecutive atrial fibrillation intervals (FF) were evaluated at three atrial sites either at arrhythmia onset or at self-termination (or at minute 5). A high-voltage burst pacing was performed after 6 minutes of stable atrial fibrillation in 10 patients. Mean FF intervals were evaluated 5 seconds before and after atrial pacing. Forty-nine atrial fibrillation episodes were induced: 39 self-terminating within 5 minutes and 10 long-lasting. A significant correlation was found between mean FF and atrial functional refractory period (r=.73, P<.001) and between fifth percentile FF and atrial effective refractory period (r=.57, P<.005). Atrial fibrillation self-termination was associated with significant mean FF prolongation, whereas long-lasting fibrillation behaved the opposite. In 10 patients, burst pacing resulted in significant shortening of the mean FF at the stimulation site; no changes were observed in the two distant recording sites. Conclusions The analysis of the FF intervals demonstrates a strict correlation with atrial functional refractoriness. The self-termination of atrial fibrillation is related to a prolongation of the functional refractoriness (mean FF), whereas a shortening of both functional and effective refractoriness (fifth percentile) is associated with atrial fibrillation persistence. The provoked shortening of the mean FF at the stimulation site is consistent with the presence of a gap of excitability during atrial fibrillation in the human atria.
A et al. (Sun,) conducted a observational in lone paroxysmal atrial fibrillation (n=25). High-voltage burst pacing was evaluated on Correlation between mean FF and atrial functional refractory period (r=0.73, p=<0.001). Mean atrial fibrillation intervals strongly correlated with atrial functional refractory period (r=0.73, P<0.001), and self-termination was associated with significant mean interval prolongation.