Verapamil eliminates the hierarchical nature of activation frequencies from the pulmonary veins to the atria during paroxysmal atrial fibrillation

Kushiyama, Yasunori; Osaka, Toshiyuki; Yokoyama, Eriko; Hasebe, Hideyuki; Kuroda, Yusuke; Kamiya, Kaichiro; Kodama, Itsuo

doi:10.1016/j.hrthm.2010.01.008

Next »Heart Rhythm
Volume 7, Issue 5 , Pages 577-583, May 2010

Verapamil eliminates the hierarchical nature of activation frequencies from the pulmonary veins to the atria during paroxysmal atrial fibrillation

Yasunori Kushiyama, MD
- Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
Toshiyuki Osaka, MD, PhD
- Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
- Address reprint requests and correspondence: Dr. Toshiyuki Osaka, Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Oshika1-1-1, Suruga-ku, Shizuoka 422-8527, Japan
Eriko Yokoyama, MD
- Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
Hideyuki Hasebe, MD
- Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
Yusuke Kuroda, MD
- Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
Kaichiro Kamiya, MD, PhD
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
Itsuo Kodama, MD, PhD
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan

Received 8 November 2009; accepted 5 January 2010. published online 11 January 2010.

Background

There is evidence that verapamil promotes the persistence of paroxysmal atrial fibrillation (AF). Little is known about the underlying mechanisms.

Objective

The purpose of this study was to determine the effect of verapamil on dominant frequencies (DFs) in the pulmonary veins (PVs) and atria during paroxysmal AF with reference to its potential arrhythmogenicity.

Methods

Forty-three patients with paroxysmal AF were studied. Bipolar electrograms were recorded simultaneously during AF from the right atrial free wall (RAFW), coronary sinus (CS) and three PVs, or two PVs and the left atrial appendage (LAA). The DFs were obtained by fast Fourier transform analysis before and after infusion of verapamil (0.1 mg/kg, intravenously).

Results

At baseline, the maximum DF among the PVs (6.9 ± 0.9 Hz) was significantly higher than the DF in the RAFW (6.2 ± 0.7 Hz), CS (5.7 ± 0.5 Hz), or LAA (5.9 ± 0.7 Hz) (P<.01); there was a substantial PV-to-atrial DF gradient (RAFW 0.7 ± 0.9, CS 1.1 ± 0.7, LAA 0.7 ± 0.9 Hz). Verapamil increased the atrial DF to 6.9 ± 0.8, 6.6 ± 0.7, and 7.2 ± 1.0 Hz in the RAFW, CS, and LAA, respectively (P<.0001) but did not affect the maximum PV DF (7.1 ± 0.7 Hz). The PV-to-atrial DF gradient was eliminated after verapamil (RAFW 0.2 ± 0.8, CS 0.5 ± 0.6, LAA −0.4 ± 0.8 Hz; P<.01 vs. baseline).