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The occurrence of atrial fibrillation depends on triggers, a substrate and
modulating factors. The substrate may be due to structural cardiac disease or remodeling due to long lasting
atrial fibrillation. In addition, in the absence of remodeling a substrate for initiation of atrial fibrillation may be
needed. We studied this initiating electrophysiologic substrate in 18 patients with idiopathic atrial fibrillation and
compared the results with a control group without this arrhythmia. After induction of atrial fibrillation by
programmed electrical stimulation, spatial dispersion of refractoriness was inferred from mean local fibrillatory
intervals. In patients with atrial fibrillation, the electrophysiologic substrate consisted of increased spatial
dispersion of refractoriness, unrelated to electrical remodeling.
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