The Mechanisms of an Increased Dominant Frequency in the Left Atrial Posterior Wall During Atrial Fibrillation in Acute Atrial Dilatation

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Abstract
Background: Previous studies have shown that the highest dominant frequency (DF) is located in the left atrium (LA) during atrial fibrillation (AF) in pacing‐induced AF. However, there have been few studies on the mechanisms of the increased DF of AF during acute atrial dilatation. The purpose of this study was to investigate the mechanisms of the increased maximal DF (max DF) in pacing‐induced AF during acute atrial dilatation. Methods: In eight Langendorff‐perfused canine hearts (26 ± 2 kg), noncontact balloon catheters were placed into the right atrium (RA) and LA, respectively. AF was induced by extrastimulation pre‐ and postdilatation in the atrium (0 and 15 cm H2O, respectively). Fast Fourier transformation analysis was performed to analyze the max DF and harmonic index (HI) from the bi‐atrial unipolar virtual electrograms during AF. The fibrillation cycle lengths were obtained from different atrial sites. The number of wavefronts was analyzed during AF. The frequency of regional splitting was defined as the number of wavefront splits per second in different atrial regions during AF. The percentage of the low‐voltage zones (Results: The DF was measured during AF. The shortest fibrillation cycle length was located in the LA posterior wall and became shorter during acute atrial dilatation. The max DF was located in the LA posterior wall and increased during acute atrial dilatation (7.1 ± 0.8 vs 8.8 ± 2.1, P = 0.02). The max DF of the LA correlated with the wavefront number (r = 0.797, P < 0.001 predilatation; r = 0.860, P < 0.001 postdilatation). The splitting of wavefronts facilitated the formation of new wavefronts. During acute atrial dilatation, the frequency of regional splitting was closely correlated with the percentage of the low‐voltage zones (r = 0.876, P < 0.001). Furthermore, the LA posterior wall had a higher percentage of the low‐voltage zones than the other sites. Conclusion: In acute atrial dilatation, the percentage of the low‐voltage zones increased, especially in the LA posterior wall, which correlated with the regional splitting of the AF wavefronts. The increase in the splitting facilitated the formation of new wavefronts and resulted in a higher max DF during acute atrial dilatation.