Lone Atrial Fibrillation: Which Anatomical and Electrophysiologic Substrate?

  • A. Capucci
  • M. Biffi
  • G. Boriani
Conference paper


Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice in all its presentation forms: paroxysmal, recurrent and chronic. Though usually associated with organic heart disease, it is also found in the absence of any structural cardiac abnormality in a substantial number of cases. Its clinical significance, prognosis, and management are largely dependent on underlying or associated heart disease; understanding the electrophysiologic (EP) mechanisms and modulating factors, such as the autonomic nervous system, is of utmost importance in the clinical management of AF patients.


Atrial Flutter Paroxysmal Atrial Fibrillation Atrial Fibrillation Patient Sick Sinus Syndrome Atrial Conduction 
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  1. 1.
    Mines GR (1913) On dynamic equilibrium in the heart. J Physio 146: 349–383Google Scholar
  2. 2.
    Lewis T, Feil S, Stroud WD (1920) Observations upon flutter and fibrillation. II. The nature of auricolar flutter. Heart 7: 191–246Google Scholar
  3. 3.
    Moe GK, Abildskov JA (1959) Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. Am Heart J 58: 59–70PubMedCrossRefGoogle Scholar
  4. 4.
    Pastelin G, Mendez R, Moe GK (1978) Participation of atrial specialized conduction pathways in atrial flutter. Circ Res 42: 386–393PubMedGoogle Scholar
  5. 5.
    Allessie MA, Bonke FIM, Schopman FJG (1976) Circus movement in rabbit atrial muscle as a mechanism of tachycardia. II. The role of nonuniform recovery of excitability in the occurrence of unidirectional block as studied with multiple micro-electrodes. Circ Res 39: 168–177PubMedGoogle Scholar
  6. 6.
    Allessie MA, Bonke FIM, Schopman FJG (1977) Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The “leading circle” concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 41: 9–18PubMedGoogle Scholar
  7. 7.
    Allessie MA, Lammers WJEP, Bonke FIM, Hollen J (1984) Intra-atrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog. Circulation 70: 123–135PubMedCrossRefGoogle Scholar
  8. 8.
    Allessie MA, Lammers WJEP, Rensma PL, Bonke FIM (1987) Flutter and fibrillation in experimental models: what has been learned that can be applied to humans? In: Brugada P, Wellens HJJ (eds) Where to go from here? Futura, Mount Kisco, pp 67–82Google Scholar
  9. 9.
    Allessie MA, Rensma W, Brugada J, Smeets JLRM, Penn O, Kirchhof CJHJ (1990) Models of atrial reentry. In: Touboul P, Waldo AL (eds) Atrial arrhythmias. Current concepts and management. Mosby, St.Louis, pp 112–130Google Scholar
  10. 10.
    Smeets JLRM, Allessie MA, Lammers WJEP, Bonke FIM, Hollen J (1986) The wavelength of the cardiac impulse and reentrant arrhythmias in isolated rabbit atrium. Circ Res 58: 96–108PubMedGoogle Scholar
  11. 11.
    Spach MS, Miller WT, Dolber PC, Kootsey M, Sommer JR, Mosher CE (1982) The functional role of structural complexities in the propagation of depolarisation in the atrium of the dog: cardiac conduction disturbances due to discontinuities of effective axial resistivity. Circ Res 50: 175–191PubMedGoogle Scholar
  12. 12.
    Spach MS Dolber PC (1986) Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Circ Res 58: 356–371PubMedGoogle Scholar
  13. 13.
    Wyndham CRC, Amat-Y-Lyon F, Wu D, Denes P, Dhingra R,Simpson R, Rosen KM (1977) Effects of cycle length on atrial vulnerability. Circulation 55: 260–267Google Scholar
  14. 14.
    Michelucci A, Padeletti L, Fradella GA (1982) Atrial refractoriness and spontaneous or induced atrial fibrillation. Acta Cardiol 37: 333–344PubMedGoogle Scholar
  15. 15.
    Michelucci A, Padeletti L, Lova RM, Fradella GA, Monizzi D, Franchi F (1982) La refrattarietà atriale e la sua dispersione in differenti condizioni fisiopatologiche. G Ital Cardiol 12: 555–562PubMedGoogle Scholar
  16. 16.
    Cosio FG, Palacios J, Vidal JM, Cocina EG, Gomez-Sanchez MA, Tamargo L (1983) Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: a possible manifestation of the background for reentry. Am J Cardiol 51: 122–136PubMedCrossRefGoogle Scholar
  17. 17.
    Attuel P, Pellerin D, Gaston J, Seing S, Quatre JM, Mugica J, Coumel P (1989) Latent atrial vulnerability: new means of electrophysiologic investigations in paroxysmal atrial fibrillation. In: Attuel P, Coumel P, Janse M (eds) The atrium in health and disease. Futura, Mount Kisco, pp. 159–200Google Scholar
  18. 18.
    Kumagai K, Akimitsu S, Kawahira K, Kawanami F, Yamanouchi Y, Hiroki T, Arakawa K (1991) EP properties in chronic atrial fibrillation. Circulation 84: 1662–1668PubMedGoogle Scholar
  19. 19.
    Luck JC, Engel TR (1979) Dispersion of atrial refractoriness in patients with sinus node dysfunction. Circulation 60: 404–412PubMedGoogle Scholar
  20. 20.
    Michelucci A, Padeletti L, Fradella GA, Lova RM, Monizzi D, Giomi A, Fantini F (1984) Ageing and atrial electrophysiologic properties in man. Int J Cardiol 5: 75–81PubMedCrossRefGoogle Scholar
  21. 21.
    Padeletti L, Michelucci A, Giovannini T, Mezzani A, Monopoli A, Franchi F (1989) Proprietà elettrofisiologiche atriali nella fibrillazione atriale parossistica. Studio effettuato stimolando cinque sedi atriali. G Ital Cardiol 19: 411–416PubMedGoogle Scholar
  22. 22.
    Boutjdir M, LeHeuzey JY, Lavergne T, Chauvaud S, Guize L, Carpentier A, Peronneau P (1986) lnhomogeneity of cellular refractoriness in human atrium: factor of arrhythmia? PACE 9: 1095–1100Google Scholar
  23. 23.
    Buxton AE, Waxman HL, Marchlinski FE, Josephson ME (1984) Atrial conduction: effects of extrastimuli with and without atrial dysrhythmias. Am J Cardiol 54: 755–761PubMedCrossRefGoogle Scholar
  24. 24.
    Ohe T, Matsuhisa M, Kamakura S, Yamada J, Sato I, Nakajima K, Shimomura K (1983) Relation between the widening of the fragmented atrial activity zone and atrial fibrillation. Am J Cardiol 53: 1219–1222CrossRefGoogle Scholar
  25. 25.
    Simpson RJ, Amara I, Foster JR, Woelfel A, Gettes LS (1988) Threshold, refractory periods and conduction times of the normal diseased human atrium. Am Heart J 116: 1080–1090PubMedCrossRefGoogle Scholar
  26. 26.
    Attuel P, Childers R, Chauchemenez B, Poveda J, Mujica J, Coumel P (1982) Failure in the rate adaptation of atrial refractory period: its relationship to vulnerability. Int J Cardiol 2: 179–197PubMedCrossRefGoogle Scholar
  27. 27.
    Capucci A, Biffi M, Boriani G, Ravelli F, Nollo G, Sabbatani P, Orsi C, Magnani B (1995) The dynamic electrophysiologic behaviour of human atria during paroxysmal atrial fibrillation. Circulation (in press)Google Scholar
  28. 28.
    Ramdat, Misier AR, Opthof T, van Hemel NM, Defauw JJAM, de Bakker JMT, Janse MJ, van Capelle FJL (1992) Increased dispersion of refractoriness in patients with idiopathic paroxysmal atrial fibrillation. J Am Coll Cardiol 1992; 19: 1531–1535CrossRefGoogle Scholar
  29. 29.
    Lammers WJEP, Allessie MA, Rensma PL, Schalij MJ (1986) The use of fibrillation cycle length to determine spatial dispersion in EP properties and to characterize the underlying mechanism of fibrillation. New Trends Arrhyth 2: 109–112Google Scholar
  30. 30.
    Cosio FG, Arribas F (1989) Role of conduction disturbances in atrial arrhythmias. In: Attuel P, Coumel P, Janse M (eds) The atrium in health and disease. Futura, Mount Kisco, pp 133–157Google Scholar
  31. 31.
    Fukunami M, Yamada T, Ohmori M, Kumagai K, Umemoto K, Sakai A, Kondoh N, Minamino T, Hoki N (1991) Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by p wave-triggered signal-averaged electrocardiogram. Circulation 83: 162–169PubMedGoogle Scholar
  32. 32.
    Opolski G, Stanislawska J, Slomka K, Kraska T (1991) Value of the atrial signal-averaged electrocardiogram in identifying patients with paroxysmal atrial fibrillation. Int J Cardiol 30: 315–319PubMedCrossRefGoogle Scholar
  33. 33.
    Cosio FG, Paylos J, Requena M, Fernandez-Vanez J (1984) Influence of basic atrial rhythm on intraatrial conduction of extrastimuli. Am J Cardini 53: 1018–1021CrossRefGoogle Scholar
  34. 34.
    Michelucci A, Lagi A, Caneschi A, Giovannini T, Mezzani A, Salvi S, Padeletti L (1990) Importance of left atrial variables in defining atrial arrhythmogenesis. New Trends Arrhyth 6: 795–800Google Scholar
  35. 35.
    Josephson ME, Horowitz LN, Farshidi A (1978) Continous local electrical activity. A mechanism of recurrent ventricular tachycardia. Circulation 57: 659–665Google Scholar
  36. 36.
    Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K (1991) Prolonged and fractionated right atrial electrograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus syndrome. J Am Coll Cardiol 17: 403–408PubMedCrossRefGoogle Scholar
  37. 37.
    Konoe A, Fukatani M, Tanigawa M, Isomoto S, Kadena M, Sakamoto T, Mori M, Shimizu A, Hashiba K (1992) ED abnormalities of the atrial muscle in patients with manifest WolffParkinson-White syndrome associated with paroxysmal atrial fibrillation. PACE 15: 1040–1052PubMedCrossRefGoogle Scholar
  38. 38.
    Capucci A, Frabetti L, Turinetto B, Pierangeli A, Magnani B (1987) Fibrillazione atriale nei post operati di by-pass aortocoronarico. Correlazione con le proprietà elettrofisiologiche valutate intraoperatoriamente. G Ital Cardiol 17: 575–582Google Scholar
  39. 39.
    Fujimura O, Klein GJ, Yee R, Sharma AD (1990) Mode of on-set of atrial fibrillation in the Wolff-Parkinson-White syndrome: how important is the accessory pathway? J Am Coll Cardiol 15: 1082–1086PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • A. Capucci
    • 1
  • M. Biffi
    • 2
  • G. Boriani
    • 2
  1. 1.Ospedale Civile di PiacenzaItaly
  2. 2.Istituto di Malattie dell’Apparato CardiovascolareUniversità degli Studi di BolognaItaly

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