Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/131915
Citations
Scopus Web of Science® Altmetric
?
?
Full metadata record
DC FieldValueLanguage
dc.contributor.authorParameswaran, R.-
dc.contributor.authorTeuwen, C.P.-
dc.contributor.authorWatts, T.-
dc.contributor.authorNalliah, C.J.-
dc.contributor.authorRoyse, A.-
dc.contributor.authorGoldblatt, J.-
dc.contributor.authorLarobina, M.-
dc.contributor.authorSanders, P.-
dc.contributor.authorKistler, P.-
dc.contributor.authorOrozco-Duque, A.-
dc.contributor.authorLee, G.-
dc.contributor.authorKalman, J.M.-
dc.date.issued2020-
dc.identifier.citationJACC: Clinical Electrophysiology, 2020; 6(1):34-44-
dc.identifier.issn2405-500X-
dc.identifier.issn2405-5018-
dc.identifier.urihttp://hdl.handle.net/2440/131915-
dc.description.abstractOBJECTIVES:The goal of this study was to describe functional endocardial-epicardial dissociation (FEED), signal complexities, and three-dimensional activation dynamics of the human atrium with structural heart disease (SHD). BACKGROUND:SHD commonly predisposes to arrhythmias. Although progressive remodeling is implicated, direct demonstration of FEED in the human atrium has not been reported previously. METHODS:Simultaneous intraoperative mapping of the endocardial and epicardial lateral right atrial wall was performed by using 2 high-density grid catheters during sinus rhythm, pacing drive (600 ms and 400 ms cycle length), and premature extrastimulation (PES). Unipolar electrograms (EGMs) were exported into custom-made software for activation and phase mapping. Difference of ≥20 ms between paired endocardial and epicardial electrodes defined dissociation. EGMs with ≥3 deflections were classified as fractionated. RESULTS:Sixteen patients (mean age 60.5 ± 4.1 years; 18.7% with a history of atrial fibrillation) with SHD (43% ischemia, 57% valvular disease) were included. A total of 9,218 EGMs were analyzed. Compared with sinus rhythm, phase and activation analyses showed significant FEED during pacing at 600 ms and 400 ms (phase mapping 22.4% vs. 10% [p < 0.0001] and 25.8% vs. 10% [p < 0.0001], respectively; activation mapping 25.4% vs. 7.8% [p < 0.0001] and 27.7% vs. 7.8% [p < 0.0001]) and PES (phase mapping 34% vs. 10% [p < 0.0001]; activation mapping 29.5% vs. 7.8% [p < 0.0001]). Fractionated EGMs occurred significantly more during PES compared with sinus rhythm (50.2% vs. 39.5%; p < 0.0001). Activation patterns differed significantly during pacing drive and PES, with preferential epicardial exit during the latter (15.9% vs. 13.8%; p = 0.046). CONCLUSIONS:Simultaneous endocardial-epicardial mapping revealed significant FEED with signal fractionation and preferential epicardial breakthroughs with PES. Such complex three-dimensional interaction in electrical activation provides mechanistic insights into atrial arrhythmogenesis with SHD.-
dc.description.statementofresponsibilityRamanathan Parameswaran, Christophe P. Teuwen, Troy Watts, Chrishan J. Nalliah, Alistair Royse, John Goldblatt ... et al.-
dc.language.isoen-
dc.publisherElsevier-
dc.rights© 2020 BY THE AMERICAN COLLEGEOF CARDIOLOGY FOUNDATION-
dc.subjectarrhythmogenesis-
dc.subjectelectrogram morphology-
dc.subjectepicardial–endocardial mapping-
dc.subjectfractionation-
dc.subjectfunctional dissociation-
dc.subjectstructural heart disease-
dc.titleFunctional atrial endocardial–epicardial dissociation in patients with structural heart disease undergoing cardiac surgery-
dc.typeJournal article-
dc.identifier.doi10.1016/j.jacep.2019.08.016-
dc.relation.grantNHMRC-
pubs.publication-statusPublished-
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]-
Appears in Collections:Aurora harvest 8
Medicine publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.