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. 1992 Dec;68(6):596–600. doi: 10.1136/hrt.68.12.596

Different distribution of abnormal endocardial electrograms within the right atrium in patients with sick sinus syndrome

Osmar Antonio Centurion 1, Masahiko Fukatani 1, Atsushi Konoe 1, Muneo Tanigawa 1, Akihiko Shimizu 1, Shojiro Isomoto 1, Muneshige Kaibara 1, Kunitake Hashiba 1
PMCID: PMC1025691  PMID: 1467054

Abstract

Background—Prolonged and fractionated right atrial endocardial electrograms are characteristic of paroxysmal atrial fibrillation (idiopathic or associated with sick sinus syndrome). The distribution of these abnormal atrial electrograms within the right atrium and the way it is related to the likelihood that patients with sick sinus syndrome will develop paroxysmal atrial fibrillation was studied.

Methods—Endocardial catheter mapping of the right atrium during sinus rhythm was performed in 41 control patients with normal sinus node function and without paroxysmal atrial fibrillation, in 33 patients with sick sinus syndrome but without tachycardia, and in 27 patients with sick sinus syndrome and paroxysmal atrial fibrillation (group 3). The bipolar electrograms were recorded at 12 sites in the right atrium and an abnormal atrial electrogram was defined as lasting ≥100 ms and/or showing eight or more fragmented deflections.

Results—1195 atrial endocardial electrograms were assessed and quantitatively measured. In patients with sick sinus syndrome and paroxysmal atrial fibrillation 54% of the abnormal atrial electrograms were recorded from the high right atrium, 28% from the mid right atrium, and 18% from the low right atrium. However, in patients with sick sinus syndrome without tachycardia 78% of the abnormal atrial electrograms were recorded from the high right atrium and 22% from the mid right atrium. No abnormal electrograms were recorded from the low right atrium.

Conclusions—In patients with sick sinus syndrome without tachycardia abnormal atrial electrograms generally came from the high right atrium but in patients with sick sinus syndrome and paroxysmal atrial fibrillation abnormal atrial electrograms were more widely distributed in the right atrium. In patients with sick sinus syndrome the greater the extent of the compromised atrial muscle, the greater the likelihood that paroxysmal atrial fibrillation will develop.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boineau J. P., Cox J. L. Slow ventricular activation in acute myocardial infarction. A source of re-entrant premature ventricular contractions. Circulation. 1973 Oct;48(4):702–713. doi: 10.1161/01.cir.48.4.702. [DOI] [PubMed] [Google Scholar]
  2. Brugada P., Abdollah H., Wellens H. J. Continuous electrical activity during sustained monomorphic ventricular tachycardia. Observations on its dynamic behavior during the arrhythmia. Am J Cardiol. 1985 Feb 1;55(4):402–411. doi: 10.1016/0002-9149(85)90384-4. [DOI] [PubMed] [Google Scholar]
  3. Cosio F. G., Arribas F., Barbero J. M., Kallmeyer C., Goicolea A. Validation of double-spike electrograms as markers of conduction delay or block in atrial flutter. Am J Cardiol. 1988 Apr 1;61(10):775–780. doi: 10.1016/0002-9149(88)91065-x. [DOI] [PubMed] [Google Scholar]
  4. Cosio F. G., Arribas F., Palacios J., Tascon J., Lopez-Gil M. Fragmented electrograms and continuous electrical activity in atrial flutter. Am J Cardiol. 1986 Jun 1;57(15):1309–1314. doi: 10.1016/0002-9149(86)90210-9. [DOI] [PubMed] [Google Scholar]
  5. El-Sherif N., Scherlag B. J., Lazzara R., Hope R. R. Re-entrant ventricular arrhythmias in the late myocardial infarction period. 1. Conduction characteristics in the infarction zone. Circulation. 1977 May;55(5):686–702. doi: 10.1161/01.cir.55.5.686. [DOI] [PubMed] [Google Scholar]
  6. Ferrer M. I. The sick sinus syndrome in atrial disease. JAMA. 1968 Oct 14;206(3):645–646. [PubMed] [Google Scholar]
  7. Ferrer M. I. The sick sinus syndrome. Circulation. 1973 Mar;47(3):635–641. doi: 10.1161/01.cir.47.3.635. [DOI] [PubMed] [Google Scholar]
  8. Fukatani M., Tanigawa M., Mori M., Konoe A., Kadena M., Shimizu A., Hashiba K. Prediction of a fatal atrial fibrillation in patients with asymptomatic Wolff-Parkinson-White pattern. Jpn Circ J. 1990 Oct;54(10):1331–1339. doi: 10.1253/jcj.54.10_1331. [DOI] [PubMed] [Google Scholar]
  9. Gardner P. I., Ursell P. C., Fenoglio J. J., Jr, Wit A. L. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation. 1985 Sep;72(3):596–611. doi: 10.1161/01.cir.72.3.596. [DOI] [PubMed] [Google Scholar]
  10. Ideker R. E., Lofland G. K., Bardy G. H., Smith W. M., Worley S. J., Wallace A. G., Cox J. L., Gallagher J. J. Late fractionated potentials and continuous electrical activity caused by electrode motion. Pacing Clin Electrophysiol. 1983 Sep;6(5 Pt 1):908–914. doi: 10.1111/j.1540-8159.1983.tb04412.x. [DOI] [PubMed] [Google Scholar]
  11. Josephson M. E., Horowitz L. N. Electrophysiologic approach to therapy of recurrent sustained ventricular tachycardia. Am J Cardiol. 1979 Mar;43(3):631–642. doi: 10.1016/0002-9149(79)90024-9. [DOI] [PubMed] [Google Scholar]
  12. Josephson M. E., Horowitz L. N., Farshidi A. Continuous local electrical activity. A mechanism of recurrent ventricular tachycardia. Circulation. 1978 Apr;57(4):659–665. doi: 10.1161/01.cir.57.4.659. [DOI] [PubMed] [Google Scholar]
  13. Josephson M. E., Wit A. L. Fractionated electrical activity and continuous electrical activity: fact or artifact? Circulation. 1984 Oct;70(4):529–532. doi: 10.1161/01.cir.70.4.529. [DOI] [PubMed] [Google Scholar]
  14. Klein H., Karp R. B., Kouchoukos N. T., Zorn G. L., Jr, James T. N., Waldo A. L. Intraoperative electrophysiologic mapping of the ventricles during sinus rhythm in patients with a previous myocardial infarction. Identification of the electrophysiologic substrate of ventricular arrhythmias. Circulation. 1982 Oct;66(4):847–853. doi: 10.1161/01.cir.66.4.847. [DOI] [PubMed] [Google Scholar]
  15. Mandel W., Hayakawa H., Danzig R., Marcus H. S. Evaluation of sino-atrial node function in man by overdrive suppression. Circulation. 1971 Jul;44(1):59–66. doi: 10.1161/01.cir.44.1.59. [DOI] [PubMed] [Google Scholar]
  16. Narula O. S., Samet P., Javier R. P. Significance of the sinus-node recovery time. Circulation. 1972 Jan;45(1):140–158. doi: 10.1161/01.cir.45.1.140. [DOI] [PubMed] [Google Scholar]
  17. Obel I. W., Cohen E., Millar R. N. Chronic symptomatic sinoatrial block: a review of 34 patients and their treatment. Chest. 1974 Apr;65(4):397–402. doi: 10.1378/chest.65.4.397. [DOI] [PubMed] [Google Scholar]
  18. Ohe T., Matsuhisa M., Kamakura S., Yamada J., Sato I., Nakajima K., Shimomura K. Relation between the widening of the fragmented atrial activity zone and atrial fibrillation. Am J Cardiol. 1983 Dec 1;52(10):1219–1222. doi: 10.1016/0002-9149(83)90577-5. [DOI] [PubMed] [Google Scholar]
  19. Olshansky B., Okumura K., Henthorn R. W., Waldo A. L. Characterization of double potentials in human atrial flutter: studies during transient entrainment. J Am Coll Cardiol. 1990 Mar 15;15(4):833–841. doi: 10.1016/0735-1097(90)90283-u. [DOI] [PubMed] [Google Scholar]
  20. Paul T., Guccione P., Garson A., Jr Relation of syncope in young patients with Wolff-Parkinson-White syndrome to rapid ventricular response during atrial fibrillation. Am J Cardiol. 1990 Feb 1;65(5):318–321. doi: 10.1016/0002-9149(90)90295-c. [DOI] [PubMed] [Google Scholar]
  21. Rubenstein J. J., Schulman C. L., Yurchak P. M., DeSanctis R. W. Clinical spectrum of the sick sinus syndrome. Circulation. 1972 Jul;46(1):5–13. doi: 10.1161/01.cir.46.1.5. [DOI] [PubMed] [Google Scholar]
  22. Shimizu A., Fukatani M., Kitano K., Tanigawa M., Ueyama C., Kiya F., Yano K., Hashiba K. The total heart beats per 24 hours by ambulatory electrocardiography and the changes of heart rate by treadmill exercise test in sick sinus syndrome. Jpn Circ J. 1988 Feb;52(2):139–148. doi: 10.1253/jcj.52.139. [DOI] [PubMed] [Google Scholar]
  23. Shimizu A., Fukatani M., Tanigawa M., Mori M., Hashiba K. Intra-atrial conduction delay and fragmented atrial activity in patients with paroxysmal atrial fibrillation. Jpn Circ J. 1989 Sep;53(9):1023–1030. doi: 10.1253/jcj.53.1023. [DOI] [PubMed] [Google Scholar]
  24. Spach M. S., Dolber P. C. Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res. 1986 Mar;58(3):356–371. doi: 10.1161/01.res.58.3.356. [DOI] [PubMed] [Google Scholar]
  25. Spach M. S., Miller W. T., 3rd, Dolber P. C., Kootsey J. M., Sommer J. R., Mosher C. E., Jr The functional role of structural complexities in the propagation of depolarization in the atrium of the dog. Cardiac conduction disturbances due to discontinuities of effective axial resistivity. Circ Res. 1982 Feb;50(2):175–191. doi: 10.1161/01.res.50.2.175. [DOI] [PubMed] [Google Scholar]
  26. Sutton R., Kenny R. A. The natural history of sick sinus syndrome. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1110–1114. doi: 10.1111/j.1540-8159.1986.tb06678.x. [DOI] [PubMed] [Google Scholar]
  27. Tanigawa M., Fukatani M., Konoe A., Isomoto S., Kadena M., Hashiba K. Prolonged and fractionated right atrial electrograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus node syndrome. J Am Coll Cardiol. 1991 Feb;17(2):403–408. doi: 10.1016/s0735-1097(10)80106-8. [DOI] [PubMed] [Google Scholar]
  28. Thery C., Gosselin B., Lekieffre J., Warembourg H. Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients. Am Heart J. 1977 Jun;93(6):735–740. doi: 10.1016/s0002-8703(77)80070-7. [DOI] [PubMed] [Google Scholar]
  29. Waxman H. L., Sung R. J. Significance of fragmented ventricular electrograms observed using intracardiac recording techniques in man. Circulation. 1980 Dec;62(6):1349–1356. doi: 10.1161/01.cir.62.6.1349. [DOI] [PubMed] [Google Scholar]
  30. Wellens H. J., Durrer D. Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol. 1974 Dec;34(7):777–782. doi: 10.1016/0002-9149(74)90695-x. [DOI] [PubMed] [Google Scholar]
  31. Wiener I., Mindich B., Pitchon R. Determinants of ventricular tachycardia in patients with ventricular aneurysms: results of intraoperative epicardial and endocardial mapping. Circulation. 1982 May;65(5):856–861. doi: 10.1161/01.cir.65.5.856. [DOI] [PubMed] [Google Scholar]
  32. Wiener I., Mindich B., Pitchon R. Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am Heart J. 1984 Jan;107(1):86–90. doi: 10.1016/0002-8703(84)90138-8. [DOI] [PubMed] [Google Scholar]

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