Functional Atrial Endocardial-Epicardial Dissociation in Patients With Structural Heart Disease Undergoing Cardiac Surgery
Ramanathan Parameswaran, Christophe P Teuwen, Troy Watts, Chrishan J Nalliah, Alistair Royse, John Goldblatt, Marco Larobina, Prashanthan Sanders, Peter Kistler, Andres Orozco-Duque, Geoffrey Lee, Jonathan M Kalman
JACC Clinical Electrophysiology | ELSEVIER | Published : 2020
OBJECTIVES: The goal of this study was to describe functional endocardial-epicardial dissociation (FEED), signal complexities, and three-dimensional activation dynamics of the human atrium with structural heart disease (SHD). BACKGROUND: SHD commonly predisposes to arrhythmias. Although progressive remodeling is implicated, direct demonstration of FEED in the human atrium has not been reported previously. METHODS: Simultaneous intraoperative mapping of the endocardial and epicardial lateral right atrial wall was performed by using 2 high-density grid catheters during sinus rhythm, pacing drive (600 ms and 400 ms cycle length), and premature extrastimulation (PES). Unipolar electrograms (EGMs..View full abstract
Drs. Parameswaran and Nalliah are supported by the National Health and Medical Research Council research scholarship. Drs. Kalman and Sanders are supported by practitioner fellowships from the National Health and Medical Research Council. Dr. Sanders is also supported by a practitioner fellowship from the National Heart Foundation; has served on the advisory board of Biosense Webster, Medtronic, St. Jude Medical, and Boston Scientific; has received lecture and/or consulting fees from Biosense Webster, Medtronic, St. Jude Medical, and Boston Scientific; and has received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik, and Sorin. Dr. Kalman has received research support from Biosense Webster, Boston Scientific, St. Jude Medical, and Medtronic; and has served on the advisory board of Boston Scientific and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Francis Marchlinski, MD, served as Guest Editor for this paper.