Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation

van Schie, M.S.; Liao, Rongheng; Ramdat Misier, Nawin L.; Knops, Paul; Heida, Annejet; Taverne, Yannick J.H.J.; de Groot, N.M.S.

doi:10.1093/europace/euad223

Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation

Title

Atrial extrasystoles enhance low-voltage fractionation electrograms in patients with atrial fibrillation

Author

van Schie, M.S. (Erasmus MC)
Liao, Rongheng (Erasmus MC)
Ramdat Misier, Nawin L. (Erasmus MC)
Knops, Paul (Erasmus MC)
Heida, Annejet (Erasmus MC)
Taverne, Yannick J.H.J. (Erasmus MC)
de Groot, N.M.S. (TU Delft Signal Processing Systems; Erasmus MC)

Date

2023

Abstract

BACKGROUND AND AIMS: Atrial extrasystoles (AES) provoke conduction disorders and may trigger episodes of atrial fibrillation (AF). However, the direction- and rate-dependency of electrophysiological tissue properties on epicardial unipolar electrogram (EGM) morphology is unknown. Therefore, this study examined the impact of spontaneous AES on potential amplitude, -fractionation, -duration, and low-voltage areas (LVAs), and correlated these differences with various degrees of prematurity and aberrancy. METHODS AND RESULTS: Intra-operative high-resolution epicardial mapping of the right and left atrium, Bachmann's Bundle, and pulmonary vein area was performed during sinus rhythm (SR) in 287 patients (60 with AF). AES were categorized according to their prematurity index (>25% shortening) and degree of aberrancy (none, mild/opposite, moderate and severe). In total, 837 unique AES (457 premature; 58 mild/opposite, 355 moderate, and 154 severe aberrant) were included. The average prematurity index was 28% [12-45]. Comparing SR and AES, average voltage decreased (-1.1 [-1.2, -0.9] mV, P < 0.001) at all atrial regions, whereas the amount of LVAs and fractionation increased (respectively, +3.4 [2.7, 4.1] % and +3.2 [2.6, 3.7] %, P < 0.001). Only weak or moderate correlations were found between EGM morphology parameters and prematurity indices (R2 < 0.299, P < 0.001). All parameters were, however, most severely affected by either mild/opposite or severely aberrant AES, in which the effect was more pronounced in AF patients. Also, there were considerable regional differences in effects provoked by AES. CONCLUSION: Unipolar EGM characteristics during spontaneous AES are mainly directional-dependent and not rate-dependent. AF patients have more direction-dependent conduction disorders, indicating enhanced non-uniform anisotropy that is uncovered by spontaneous AES.

Subject

Anisotropy
Atrial extrasystole
Atrial fibrillation
Conduction disorders
Fractionation
High-resolution epicardial mapping
Low-voltage areas
Potential morphology
Sinus rhythm
Unipolar voltage