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Kim, Shin, Hong, Park, Kim, Shim, Kim, and Lee: Effect of Left Atrial Decompression by Percutaneous Balloon Mitral Commissurotomy on the Atrial Electrophysiologic Properties
Original Article
Korean Circulation Journal

Korean Circulation Journal 2007; 37(5): 208-215.

Published online: 31 May 2007

DOI: https://doi.org/10.4070/kcj.2007.37.5.208

Effect of Left Atrial Decompression by Percutaneous Balloon Mitral Commissurotomy on the Atrial Electrophysiologic Properties

Hyong-Jun Kim, MD, Dong-Gu Shin, MD, Geu-Ru Hong, MD, Jong-Seon Park, MD, Young-Jo Kim, MD, Bong-Sup Shim, MD, Woong Kim, MD, Sang-Hee Lee, MD

Cardiovascular Division, Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

Corresponding author (dgshin@med.yu.ac.kr)

Received 14 December 2006       Accepted 30 March 2007

© 2007, The Korean Society of Circulation

Abstract

Background and Objectives

Atrial dilatation contributes to the inducibility of atrial fibrillation (AF) by changing the atrial electrophysiological properties. There has been no report regarding the electrophysiologic data of the left atrium (LA), where the most significant electrophysiological impact might be expected to occur in case of mitral stenosis (MS). We investigated the electrophysiological changes after reduction of the LA pressure in patients who were undergoing percutaneous balloon mitral commissurotomy (PBMC).

Subjects and Methods

We studied 26 patients (21 women, age range: 50±12 years) with MS, including 7 sinus rhythm (SR) patients. The effective refractory period (ERP), the monophasic action potential duration (MAPD90), and the conduction time (CT) were measured simultaneously in both atriums at 600, 500, 400 and 300 ms of drive cycle length (DCL). The restitution slope (RS) was also calculated by the S1S2 method. The atrial fibrillation cycle length (AFCL) and dominant frequency (DF) for the cases of AF were also calculated. All the measurements were repeated after PBMC.

Results

The mean LA pressure was significantly reduced after PBMC in both the AF and SR patients (17.0±5.5 mmHg vs 10.4±4.0 mmHg, respectively, p<0.01, 17.6±7.1 mmHg vs 9.0±2.8 mmHg, respectively, p<0.01). A significant increase of ERP was observed in the LA after PBMC, but not in the right atrium (RA). The increase of MAPD90 after PBMC was significant in the LA at all the tested DCLs, but not in the RA. The CT was also significantly decreased at all the tested DCLs after PBMC. The RS of the LA decreased from 1.71±0.82 to 0.76±0.33 after PBMC (p=0.056). However, no significant changes of the AFCL or DF after PBMC were observed in the AF group.

Conclusion

Chronic atrial stretch altered the atrial electrophysiological milieu, especially in the LA, which was partially reversible in SR patients. This result supports the theoretical basis for the beneficial effects of early intervention to reduce the atrial pressure overload in MS patients.

Keywords: Atrium, Arrhythmia, Mitral stenosis, Electrophysiology

Figures and Tables

Fig. 1
ERP change after left atrial decompression. A significant increase of ERP was observed in the LA after PBMC, but not in the RA. ERP: effective refractory period at 600 ms drive cycle length, LA: left atrium, PBMC: percutaneous balloon mitral commissurotomy, RA: right atrium, NS: not significant.
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Fig. 2
Conduction time change after left atrial decompression. The CT decreased significantly at all the tested DCLs except 600 ms DCL after PBMC. CT: conduction time, DCL: drive cycle length, PBMC: percutaneous balloon mitral commissurotomy. *: p<0.05.
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Fig. 3
MAP90 change after left atrial decompression. The increases of MAP90 after PBMC were significant in the LA at all the tested DCLs, but not in the RA. MAP90: 90% monophasic action potential duration at 600 ms drive cycle length, PBMC: percutaneous balloon mitral commissurotomy, LA: left atrium, RA: right atrium, DCL: drive cycle length, NS: not significant. *: p<0.05, †: p<0.01.
kcj-37-208-g003
Fig. 4
Change of maximal APD restitution slope after PBMC decompression. APD: action potential duration, PBMC: percutaneous balloon mitral commissurotomy, RA: right atrium, LA: left atrium, NS: not significant.
kcj-37-208-g004
Fig. 5
Dominant frequency change after left atrial decompression. Empty bar means DF at both atrium before PBMC, and Filled bar, after PBMC. PBMC: percutaneous balloon mitral commissurotomy, DF: dominant frequency in Hz, RA: right atrium, LA: left atrium, NS: not significant.
kcj-37-208-g005
Fig. 6
Atrial fibrillation induced by single atrial stimulation. AF induced by a single atrial stimulation (600/230 ms) in a patient with sinus rhythm during pre-PBMC. AF induction was abolished after PBMC. AF: atrial fibrillation, PBMC: percutaneous balloon mitral commissurotomy.
kcj-37-208-g006
Table 1
Echocardiographic and PBMC procedural data
kcj-37-208-i001

PBMC: percutaneous balloon mitral commissurotomy, AF: atrial fibrillation, LAD: left atrial diameter, MVA: mitral valve area, LA: left atrium, LAPG: left atrial pressure gradient, RA: right atrium, NS: not significant

Table 2
Electrophysiologic effect of left atrial decompression by PBMC
kcj-37-208-i002

PBMC: percutaneous balloon mitral commissurotomy, ERP: effective refractory period at 600 ms drive cycle length, MAP90: 90% monophasic action potential duration at 600 ms drive cycle length, AFCL: mean AF cycle length in ms, DF: dominant frequency in Hz, Slope: maximal APD restitution slope, NS: not significant

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