A new view of anatomic substrate, electrophysiological mechanisms of atrial fibrillation, and results of interventional treatment

Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with a...

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Published inVestnik Rossiĭskoĭ akademii medits︠i︡nskih nauk no. 4; p. 38
Main Authors Revishvili, A Sh, Serov, R A, Imnadze, G G, Bokeriia, L A
Format Journal Article
LanguageRussian
Published Russia (Federation) 2005
Subjects
Adolescent
Adult
Aged
Atrial Fibrillation - pathology
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Catheter Ablation - methods
Child
Electric Stimulation Therapy - methods
Female
Heart Atria - physiopathology
Heart Atria - ultrastructure
Humans
In Vitro Techniques
Male
Microscopy, Electron
Middle Aged
Myocardial Contraction - physiology
Pulmonary Veins - ultrastructure
Retrospective Studies
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Summary:Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with atrial fibrillation (AF) for ultrastructural study. The investigation found myocardial sleeves (MS) in 86.3% of cases, an additional PV between right PVs--in 15%, a collector type of superior and inferior PV--in 25% of cases. MS were situated on the adventitial side of PVs; along the whole length of the PVs the MS myocyte fascicles ran in different directions. Local changes, such as productive myocarditis, fibrosis and fibro-lipomatosis, were observed in MS of PV of patients with AF. 106 patients (80 of whom were male; middle age 42.9 +/- 12.5 years) with symptomatic AF underwent clinical examination. Electrophysiological features of the PVs were evaluated in 30 patients. Effective and functional refractory periods of PVs were found to be shorter than those of the left atrium and non-arrhythmogenic PVs. Radiofrequency ablation (RA) with application of electrophysiological criteria proved to be effective in all patients with frequent ectopy from PVs. The use of electroanatomical mapping allowed successful RA in 82% of patients with persistent and chronic AF. The study demonstrates that the changes in MS of PV, discovered by means of light and electron microscopy, as well as their complex three-dimensional morphological structure may cause and maintain AF. Very distinct electrophysiological features, found in AF patients, probably play a major role in arrhythmogenicity.
ISSN:0869-6047