14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-132

Mapping of the atrial fibrillation: relevant observations to guide radiofrequency ablation

M. Adam, M. Pirrami, P. Franciosa, G. Carreras, M.G. Bendini, M. Ridarelli, G. Bagliani*, Annibale S. Montenero
Cardiology Department, S. Maria Hospital, Terni, *Cardiology Dept., Foligno Hospital, Foligno, Italy

Reasons to map and cure atrial fibrillation

Advances in understanding of the electrophysiological mechanism responsible for the maintenance of atrial fibrillation have brought with them the recognition that this arrhythmia may cause a tachycardia-induced atrial cardiomyopathy that results in electrophysiological and anatomic remodeling of the atria.

The term “electrical remodeling”, now frequently used, has been introduced by Wijffels⁶ to indicate long-term changes in refractory period that resulted in loss of rate adaptation and caused an increase in the rate, inducibility, and stability of the atrial fibrillation.

These electrophysiological changes lead to short term (seconds or minutes) and then to mild (hours or day) or very long-term (months or years) metabolic changes that result to irreversible structural damage (fibrosis, fatty degeneration). Thus the “electrical remodeling” may lead to an “anatomical remodeling”. Moreover recently Elvan⁷ confirmed the findings of Wijffels and found that rapid pacing-induced atrial fibrillation in dogs prolonged intra-atrial conduction time and also depressed sinus node function. This latter observation raises the possibility that the tachycardia-induced atrial myopathy also causes sinus node remodeling and may contribute to clinical presentation such as the bradycardia-tachycardia syndrome.

Thus attempts to restore sinus rhythm are warranted under the premise that sinus rhythm begets sinus rhythm.