TY - JOUR
T1 - Biatrial arrhythmogenic substrate in patients with hypertrophic obstructive cardiomyopathy
AU - Ramdat Misier, Nawin L.
AU - Amesz, Jorik H.
AU - Taverne, Yannick J. H. J.
AU - Nguyen, Hoang
AU - van Schie, Mathijs S.
AU - Knops, Paul
AU - Schinkel, Arend F. L.
AU - de Jong, Peter L.
AU - Brundel, Bianca J. J. M.
AU - de Groot, Natasja M. S.
N1 - Publisher Copyright: © 2024 Heart Rhythm Society
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Atrial myopathy
KW - Hypertrophic obstructive cardiomyopathy
KW - Mapping
KW - Myectomy
UR - http://www.scopus.com/inward/record.url?scp=85186102267&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2024.01.022
DO - 10.1016/j.hrthm.2024.01.022
M3 - Article
C2 - 38246568
SN - 1547-5271
JO - Heart Rhythm
JF - Heart Rhythm
ER -