Biatrial arrhythmogenic substrate in patients with hypertrophic obstructive cardiomyopathy.
Heart Rhythm
; 21(6): 819-827, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38246568
ABSTRACT
BACKGROUND:
Atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM) may be caused by a primary atrial myopathy. Whether HOCM-related atrial myopathy affects mainly electrophysiological properties of the left atrium (LA) or also the right atrium (RA) has never been investigated.OBJECTIVE:
The purpose of this study was to characterize atrial conduction and explore differences in the prevalence of conduction disorders, potential fractionation, and low-voltage areas (LVAs) between the RA and LA during sinus rhythm (SR) as indicators of potential arrhythmogenic areas.METHODS:
Intraoperative epicardial mapping of both atria during SR was performed in 15 HOCM patients (age 50 ± 12 years). Conduction delay (CD) and conductin block (CB), unipolar potential characteristics (voltages, fractionation), and LVA were quantified.RESULTS:
Conduction disorders and LVA were found scattered throughout both atria in all patients and did not differ between the RA and LA (CD 2.9% [1.9%-3.6%] vs 2.6% [2.1%-6.4%], P = .541; CB 1.7% [0.9%-3.1%] vs 1.5% [0.5%-2.8%], P = .600; LVA 4.7% [1.6%-7.7%] vs 2.9% [2.1%-7.1%], P = .793). Compared to the RA, unipolar voltages of single potentials (SPs) and fractionated potentials (FPs) were higher in the LA (SP P75 7.3 mV vs 10.9 mV; FP P75 2.0 mV vs 3.7 mV). FP contained low-voltage components in only 18% of all LA sites compared to 36% of all RA sites.CONCLUSION:
In patients with HOCM, conduction disorders, LVA, and FP are equally present in both atria, supporting the hypothesis of a primary atrial myopathy. Conceptually, the presence of a biatrial substrate and high-voltage FP may contribute to failure of ablative therapy of atrial tachyarrhythmias in this population.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
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Cardiomiopatia Hipertrófica
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Átrios do Coração
Tipo de estudo:
Risk_factors_studies
Limite:
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article