Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling

Background: Sole pulmonary vein (PV) isolation by ablation therapy prevents atrial fibrillation (AF) in patients with short episodes of AF and without comorbidities. Since incomplete PV isolation can be curative, we tested the hypothesis that the PV in the absence of remodeling and comorbidities con...

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Autores principales:	Lisa A. Gottlieb, Charly Belterman, Shirley van Amersfoorth, Virginie Loyer, Marion Constantin, Mélèze Hocini, Lukas R. C. Dekker, Ruben Coronel
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	atrial fibrillation arrhythmogenesis pulmonary vein histology sheep model refractoriness Physiology QP1-981
Acceso en línea:	https://doaj.org/article/d2e0e0d076e44196aaad7c610c49ae34
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spelling	oai:doaj.org-article:d2e0e0d076e44196aaad7c610c49ae342021-11-30T18:30:01ZProfibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling1664-042X10.3389/fphys.2021.748203https://doaj.org/article/d2e0e0d076e44196aaad7c610c49ae342021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphys.2021.748203/fullhttps://doaj.org/toc/1664-042XBackground: Sole pulmonary vein (PV) isolation by ablation therapy prevents atrial fibrillation (AF) in patients with short episodes of AF and without comorbidities. Since incomplete PV isolation can be curative, we tested the hypothesis that the PV in the absence of remodeling and comorbidities contains structural and functional properties that are proarrhythmic for AF initiation by reentry.Methods: We performed percutaneous transvenous in vivo endocardial electrophysiological studies and quantitative histological analysis of PV from healthy sheep.Results: The proximal PV contained more myocytes than the distal PV and a higher percentage of collagen and fat tissue relative to myocytes than the left atrium. Local fractionated electrograms occurred in both the distal and proximal PVs, but a large local activation (>0.75 mV) was more often present in the proximal PV than in the distal PV (86 vs. 50% of electrograms, respectively, p = 0.017). Atrial arrhythmias (run of premature atrial complexes) occurred more often following the premature stimulation in the proximal PV than in the distal PV (p = 0.004). The diastolic stimulation threshold was higher in the proximal PV than in the distal PV (0.7 [0.3] vs. 0.4 [0.2] mA, (median [interquartile range]), p = 0.004). The refractory period was shorter in the proximal PV than in the distal PV (170 [50] vs. 248 [52] ms, p < 0.001). A linear relation existed between the gradient in refractoriness (distal-proximal) and atrial arrhythmia inducibility in the proximal PV.Conclusion: The structural and functional properties of the native atrial-PV junction differ from those of the distal PV. Atrial arrhythmias in the absence of arrhythmia-induced remodeling are caused by reentry in the atrial-PV junction. Ablative treatment of early paroxysmal AF, rather than complete isolation of focal arrhythmia, may be limited to inhibition of reentry.Lisa A. GottliebLisa A. GottliebCharly BeltermanShirley van AmersfoorthVirginie LoyerMarion ConstantinMélèze HociniLukas R. C. DekkerLukas R. C. DekkerRuben CoronelRuben CoronelFrontiers Media S.A.articleatrial fibrillationarrhythmogenesispulmonary veinhistologysheep modelrefractorinessPhysiologyQP1-981ENFrontiers in Physiology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation arrhythmogenesis pulmonary vein histology sheep model refractoriness Physiology QP1-981
spellingShingle	atrial fibrillation arrhythmogenesis pulmonary vein histology sheep model refractoriness Physiology QP1-981 Lisa A. Gottlieb Lisa A. Gottlieb Charly Belterman Shirley van Amersfoorth Virginie Loyer Marion Constantin Mélèze Hocini Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
description	Background: Sole pulmonary vein (PV) isolation by ablation therapy prevents atrial fibrillation (AF) in patients with short episodes of AF and without comorbidities. Since incomplete PV isolation can be curative, we tested the hypothesis that the PV in the absence of remodeling and comorbidities contains structural and functional properties that are proarrhythmic for AF initiation by reentry.Methods: We performed percutaneous transvenous in vivo endocardial electrophysiological studies and quantitative histological analysis of PV from healthy sheep.Results: The proximal PV contained more myocytes than the distal PV and a higher percentage of collagen and fat tissue relative to myocytes than the left atrium. Local fractionated electrograms occurred in both the distal and proximal PVs, but a large local activation (>0.75 mV) was more often present in the proximal PV than in the distal PV (86 vs. 50% of electrograms, respectively, p = 0.017). Atrial arrhythmias (run of premature atrial complexes) occurred more often following the premature stimulation in the proximal PV than in the distal PV (p = 0.004). The diastolic stimulation threshold was higher in the proximal PV than in the distal PV (0.7 [0.3] vs. 0.4 [0.2] mA, (median [interquartile range]), p = 0.004). The refractory period was shorter in the proximal PV than in the distal PV (170 [50] vs. 248 [52] ms, p < 0.001). A linear relation existed between the gradient in refractoriness (distal-proximal) and atrial arrhythmia inducibility in the proximal PV.Conclusion: The structural and functional properties of the native atrial-PV junction differ from those of the distal PV. Atrial arrhythmias in the absence of arrhythmia-induced remodeling are caused by reentry in the atrial-PV junction. Ablative treatment of early paroxysmal AF, rather than complete isolation of focal arrhythmia, may be limited to inhibition of reentry.
format	article
author	Lisa A. Gottlieb Lisa A. Gottlieb Charly Belterman Shirley van Amersfoorth Virginie Loyer Marion Constantin Mélèze Hocini Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel
author_facet	Lisa A. Gottlieb Lisa A. Gottlieb Charly Belterman Shirley van Amersfoorth Virginie Loyer Marion Constantin Mélèze Hocini Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel
author_sort	Lisa A. Gottlieb
title	Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
title_short	Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
title_full	Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
title_fullStr	Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
title_full_unstemmed	Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling
title_sort	profibrillatory structural and functional properties of the atrial-pulmonary junction in the absence of remodeling
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/d2e0e0d076e44196aaad7c610c49ae34
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Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling

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