Importance of geometry and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis. Export

@article{citeulike:710697, abstract = {BACKGROUND: The critical mass hypothesis for atrial fibrillation (AF) was proposed in 1914. There has never been a systematic investigation defining the relationship between tissue geometry and AF. The purpose of this study was to determine the association among the probability of maintaining AF and the width, area, weight, effective refractory period (ERP), and wavelength in atrial tissue. METHODS AND RESULTS: Isolated canine atria (n=20) were perfused with Krebs-Henseleit solution. Baseline ERPs were obtained with and without acetylcholine (10E-3.5 mol/L) using single extra-stimulus pacing while unipolar electrograms were recorded from 250 sites. The tissue was then partitioned using bipolar radiofrequency ablation, and the ERPs were measured again with and without acetylcholine. Any section of tissue that maintained AF was divided until the arrhythmia was no longer inducible. ERPs and conduction velocities were measured in all of the sections after each ablation, and the wavelengths were calculated. The probability of AF was found to be correlated with increasing tissue areas, widths, and weights (P<0.001). The probability of AF was significantly associated with the length of the ERP and the wavelength (P<0.001). With shorter ERPs and shorter wavelengths, there was an increased probability of sustained AF. CONCLUSIONS: The probability of sustained AF was significantly associated with increasing tissue area, width, and weight and decreasing ERPs and wavelengths. These data may lead to a better understanding of the mechanism of AF and, thus, help to design more-effective interventional procedures in the future.}, address = {Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.}, author = {Byrd, G. D. and Prasad, S. M. and Ripplinger, C. M. and Cassilly, T. R. and Schuessler, R. B. and Boineau, J. P. and Damiano, R. J.}, citeulike-article-id = {710697}, citeulike-linkout-0 = {http://dx.doi.org/10.1161/CIRCULATIONAHA.104.526210}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16159868}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16159868}, day = {30}, doi = {10.1161/CIRCULATIONAHA.104.526210}, issn = {1524-4539}, journal = {Circulation}, keywords = {atrial, critical-mass}, month = {August}, number = {9 Suppl}, posted-at = {2006-06-26 05:53:36}, priority = {2}, title = {Importance of geometry and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis.}, url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.104.526210}, volume = {112}, year = {2005} }

TY - JOUR ID - citeulike:710697 L3 - citeulike-article-id:710697 N2 - BACKGROUND: The critical mass hypothesis for atrial fibrillation (AF) was proposed in 1914. There has never been a systematic investigation defining the relationship between tissue geometry and AF. The purpose of this study was to determine the association among the probability of maintaining AF and the width, area, weight, effective refractory period (ERP), and wavelength in atrial tissue. METHODS AND RESULTS: Isolated canine atria (n=20) were perfused with Krebs-Henseleit solution. Baseline ERPs were obtained with and without acetylcholine (10E-3.5 mol/L) using single extra-stimulus pacing while unipolar electrograms were recorded from 250 sites. The tissue was then partitioned using bipolar radiofrequency ablation, and the ERPs were measured again with and without acetylcholine. Any section of tissue that maintained AF was divided until the arrhythmia was no longer inducible. ERPs and conduction velocities were measured in all of the sections after each ablation, and the wavelengths were calculated. The probability of AF was found to be correlated with increasing tissue areas, widths, and weights (P<0.001). The probability of AF was significantly associated with the length of the ERP and the wavelength (P<0.001). With shorter ERPs and shorter wavelengths, there was an increased probability of sustained AF. CONCLUSIONS: The probability of sustained AF was significantly associated with increasing tissue area, width, and weight and decreasing ERPs and wavelengths. These data may lead to a better understanding of the mechanism of AF and, thus, help to design more-effective interventional procedures in the future. IS - 9 Suppl JF - Circulation SN - 1524-4539 AD - Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. TI - Importance of geometry and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis. VL - 112 KW - atrial KW - critical-mass AU - Byrd, GD AU - Prasad, SM AU - Ripplinger, CM AU - Cassilly, TR AU - Schuessler, RB AU - Boineau, JP AU - Damiano, RJ PY - 2005/08/30/ UR - http://dx.doi.org/10.1161/CIRCULATIONAHA.104.526210 ER -