Author + information
- Received August 15, 2019
- Revision received November 6, 2019
- Accepted December 5, 2019
- Published online May 18, 2020.
- Charlotte A. Houck, MDa,b,∗,
- Eva A.H. Lanters, MDa,∗,
- Annejet Heida, MDa,
- Yannick J.H.J. Taverne, MD, PhDb,
- Pieter C. van de Woestijne, MDb,
- Paul Knops, BSca,
- Maarten C. Roos-Serote, PhDa,
- Jolien W. Roos-Hesselink, MD, PhDa,
- Ad J.J.C. Bogers, MD, PhDb and
- Natasja M.S. de Groot, MD, PhDa,∗ ()
- aDepartment of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- bDepartment of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Natasja M.S. de Groot, Erasmus Medical Center, Department of Cardiology, RG-619, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
Objectives This study sought to quantify characteristics of atrial conduction disorders in patients with right atrial (RA) volume overload.
Background Patients with an interatrial shunt are prone to developing atrial fibrillation (AF), which may be related to conduction disorders occurring due to atrial stretch.
Methods Thirty-one patients undergoing surgery for an interatrial shunt (49 ± 14 years of age) underwent epicardial sinus rhythm mapping of the RA, Bachmann’s bundle (BB), and left atrium (LA). Conduction delay (CD) was defined as interelectrode conduction time (CT) of 7 to 11 ms and conduction block (CB) as CT ≥12 ms. Prevalence of CD or CB (percentage of mapped region), length of lines, and severity of CB (75th percentile of CTs ≥12 ms) were analyzed.
Results All patients had some degree of CD and CB. Prevalence of CD and CB was higher in the RA and BB than in the LA (p < 0.0083 after Bonferroni correction). The longest CB line within each patient was found in the RA in most patients (52%). Interindividual variation in prevalence and lengths of lines was considerable. CB was more severe in the RA than in the LA (p < 0.0083). Within the RA, conduction disorders were more prevalent and more severe in the intercaval region than in the RA free wall (p < 0.05).
Conclusions In patients with an interatrial shunt, conduction disorders during sinus rhythm are most pronounced in the RA—particularly the intercaval region—and BB. Knowledge of the conduction during sinus rhythm is essential to determine the relevance of conduction disorders for initiation and perpetuation of AF.
- adult congenital heart disease
- atrial septal defect
- conduction disorders
- epicardial mapping
- sinus rhythm
↵∗ Drs. Houck and Lanters contributed equally to this work and are joint first authors.
This work was supported by grants from CVON-AFFIP (914728), NWO-Vidi (91717339), Biosense Webster USA (ICD 783454), and Medical Delta (to Dr. de Groot). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 15, 2019.
- Revision received November 6, 2019.
- Accepted December 5, 2019.
- 2020 American College of Cardiology Foundation
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