The relation between atrial fibrillation wavefront characteristics and accessory pathway conduction

James J.C. Ong, Yong Mei Cha, Jolene M. Kriett, Ker Boyce, Gregory K. Feld, Peng Sheng Chen

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Although the source-sink relationship for impulse propagation in cardiac tissues has been demonstrated in vitro, there has been no verification of this hypothesis in humans. Accordingly, eight patients undergoing surgical division of their accessory pathways were studied. A 56-channel (7 x 8) bipolar plaque electrode array was placed over the atrioventricular groove on the accessory pathway and atrial fibrillation electrically induced. 10 episodes of QRS transition from consecutively preexcited to nonpreexcited complexes were analyzed. This showed that consecutively preexcited QRS complexes were always associated with uniform large atrial wavefronts. Immediately prior to QRS transition, four general types of changes were observed: (a) premature invasion by secondary wavefronts creating local conduction block (n = 5); (b) wavefront collision leading to wavefront curvature (n = 2); (c) transition from a uniform large atrial wavefront to multiple fractionated small wavefronts (n = 1); and (d) uniform atrial wavefronts 'marching' into the accessory pathway refractory period (n = 2). We conclude that local atrial wavefront characteristics are important factors influencing impulse propagation through the accessory pathway. The findings that local wavefront collision, curvature, or fractionation often precede loss of accessory pathway conduction support the notion that source-sink relationship is an important determinant of the safety factor for impulse propagation in the human heart.

Original languageEnglish (US)
Pages (from-to)2284-2296
Number of pages13
JournalJournal of Clinical Investigation
Volume96
Issue number5
DOIs
StatePublished - Nov 1995
Externally publishedYes

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Keywords

  • Wolff-Parkinson-White syndrome
  • electrophysiology
  • impulse propagation
  • safety factor
  • source-sink relationship

ASJC Scopus subject areas

  • Medicine(all)

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