Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping

Rishi Arora, Sander Verheule, Luis Scott, Antonio Navarrete, Vikram Katari, Emily Wilson, Dev Vaz, Jeffrey E. Olgin

Research output: Contribution to journalArticle

256 Citations (Scopus)

Abstract

Background - It has recently been recognized that atrial fibrillation can originate from focal sources in the pulmonary veins (PVs). However, the mechanisms of focal atrial fibrillation have not been well characterized. We assessed the electrophysiological characteristics of the PVs using high-resolution optical mapping. Methods and Results - Coronary-perfused, isolated whole-atrial preparations from 33 normal dogs were studied. Programmed electrical stimulation was performed, and a 4-cm2 area of the PV underwent optical mapping of transmembrane voltage to obtain 256 simultaneous action potentials. Marked conduction slowing was seen at the proximal PV, compared with the rest of the vein, on both the epicardial (31.3±4.47 versus 90.2±20.7 cm/s, P=0.001) and endocardial (45.8±6.90 versus 67.6±10.4 cm/s, P=0.012) aspects. Pronounced repolarization heterogeneity was also noted, with action potential duration at 80% repolarization being longest at the PV endocardium. Nonsustained reentrant beats were induced with single extrastimuli, and the complete reentrant loop was visualized (cycle length, 155±30.3 ms); reentrant activity could be sustained with isoproterenol. Sustained focal discharge (cycle length, 330 to 1100 ms) was seen from the endocardial surface in the presence of isoproterenol; each focus was localized near the venous ostium. Conclusions - The normal PV seems to have the necessary substrate to support reentry as well as focal activity. Although reentry occurred more distally in the vein, focal activity seemed to occur more proximally.

Original languageEnglish (US)
Pages (from-to)1816-1821
Number of pages6
JournalCirculation
Volume107
Issue number13
DOIs
StatePublished - Apr 8 2003

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Pulmonary Veins
Isoproterenol
Atrial Fibrillation
Action Potentials
Veins
Endocardium
Electric Stimulation
Dogs

Keywords

  • Atrium
  • Electrophysiology
  • Fibrillation
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Arora, R., Verheule, S., Scott, L., Navarrete, A., Katari, V., Wilson, E., ... Olgin, J. E. (2003). Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. Circulation, 107(13), 1816-1821. https://doi.org/10.1161/01.CIR.0000058461.86339.7E

Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. / Arora, Rishi; Verheule, Sander; Scott, Luis; Navarrete, Antonio; Katari, Vikram; Wilson, Emily; Vaz, Dev; Olgin, Jeffrey E.

In: Circulation, Vol. 107, No. 13, 08.04.2003, p. 1816-1821.

Research output: Contribution to journalArticle

Arora, R, Verheule, S, Scott, L, Navarrete, A, Katari, V, Wilson, E, Vaz, D & Olgin, JE 2003, 'Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping', Circulation, vol. 107, no. 13, pp. 1816-1821. https://doi.org/10.1161/01.CIR.0000058461.86339.7E
Arora R, Verheule S, Scott L, Navarrete A, Katari V, Wilson E et al. Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. Circulation. 2003 Apr 8;107(13):1816-1821. https://doi.org/10.1161/01.CIR.0000058461.86339.7E
Arora, Rishi ; Verheule, Sander ; Scott, Luis ; Navarrete, Antonio ; Katari, Vikram ; Wilson, Emily ; Vaz, Dev ; Olgin, Jeffrey E. / Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. In: Circulation. 2003 ; Vol. 107, No. 13. pp. 1816-1821.
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AU - Arora, Rishi

AU - Verheule, Sander

AU - Scott, Luis

AU - Navarrete, Antonio

AU - Katari, Vikram

AU - Wilson, Emily

AU - Vaz, Dev

AU - Olgin, Jeffrey E.

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N2 - Background - It has recently been recognized that atrial fibrillation can originate from focal sources in the pulmonary veins (PVs). However, the mechanisms of focal atrial fibrillation have not been well characterized. We assessed the electrophysiological characteristics of the PVs using high-resolution optical mapping. Methods and Results - Coronary-perfused, isolated whole-atrial preparations from 33 normal dogs were studied. Programmed electrical stimulation was performed, and a 4-cm2 area of the PV underwent optical mapping of transmembrane voltage to obtain 256 simultaneous action potentials. Marked conduction slowing was seen at the proximal PV, compared with the rest of the vein, on both the epicardial (31.3±4.47 versus 90.2±20.7 cm/s, P=0.001) and endocardial (45.8±6.90 versus 67.6±10.4 cm/s, P=0.012) aspects. Pronounced repolarization heterogeneity was also noted, with action potential duration at 80% repolarization being longest at the PV endocardium. Nonsustained reentrant beats were induced with single extrastimuli, and the complete reentrant loop was visualized (cycle length, 155±30.3 ms); reentrant activity could be sustained with isoproterenol. Sustained focal discharge (cycle length, 330 to 1100 ms) was seen from the endocardial surface in the presence of isoproterenol; each focus was localized near the venous ostium. Conclusions - The normal PV seems to have the necessary substrate to support reentry as well as focal activity. Although reentry occurred more distally in the vein, focal activity seemed to occur more proximally.

AB - Background - It has recently been recognized that atrial fibrillation can originate from focal sources in the pulmonary veins (PVs). However, the mechanisms of focal atrial fibrillation have not been well characterized. We assessed the electrophysiological characteristics of the PVs using high-resolution optical mapping. Methods and Results - Coronary-perfused, isolated whole-atrial preparations from 33 normal dogs were studied. Programmed electrical stimulation was performed, and a 4-cm2 area of the PV underwent optical mapping of transmembrane voltage to obtain 256 simultaneous action potentials. Marked conduction slowing was seen at the proximal PV, compared with the rest of the vein, on both the epicardial (31.3±4.47 versus 90.2±20.7 cm/s, P=0.001) and endocardial (45.8±6.90 versus 67.6±10.4 cm/s, P=0.012) aspects. Pronounced repolarization heterogeneity was also noted, with action potential duration at 80% repolarization being longest at the PV endocardium. Nonsustained reentrant beats were induced with single extrastimuli, and the complete reentrant loop was visualized (cycle length, 155±30.3 ms); reentrant activity could be sustained with isoproterenol. Sustained focal discharge (cycle length, 330 to 1100 ms) was seen from the endocardial surface in the presence of isoproterenol; each focus was localized near the venous ostium. Conclusions - The normal PV seems to have the necessary substrate to support reentry as well as focal activity. Although reentry occurred more distally in the vein, focal activity seemed to occur more proximally.

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