Stretch and inflammation - Their relation to fractionation of electrograms in atrial fibrillation

Uma N Srivatsa, Mary Chavez, Sankar Krishnamurthy, Zhongmin Li, Hong Qiu, Nipavan Chiamvimonvat

Research output: Contribution to journalArticlepeer-review


Background: Inflammatory markers (IM) are elevated in atrial fibrillation (AF). However the relation of IM to substrate modification in AF remains unclear. We sought to assess the relationship of IM to fractionated atrial electrogram (FAE) in patients undergoing AF ablation. Methods: At baseline, left atrial (LA) pressure was recorded and peripheral blood was tested for IM. FAE mapping was performed before and after circumferential pulmonary vein and linear ablation (CPVA-L) and followed by FAE ablation. Image processing was used to define the FAE areas. AF cycle-length (AFCL) was compared between baseline and after ablations from left atrial electrode. Results: Older patients had higher cytokine levels. FAE area at baseline (secondary FAE) negatively correlated with the levels of interleukin-6 (IL-6, R2= -0.97 and p=0.03) and interleukin-12p70 (IL-12p70, R2= -0.97 and p=0.03). In addition, a significant reduction in FAE area and index occurred after CPVA-L (p=0.0001). FAE after CPVA-L (primary FAE) correlated with left atrial pressure (LAP), [R2 0.5, (p=0.02)]. The AFCL (in msec) increased from 135 ± 41 to 149.5+30 (p=ns) after CPVA-L and further increased to 191.5 ± 60 (p=0.007) after FAE ablation. Conclusions: There is a negative correlation of IL-6 and IL-12p70 to baseline FAE, suggesting a possibility of sequestration of these cytokines in left atrium. CPVA-L ablation reduces FAE area which when ablated increases AFCL, suggesting that these areas likely represent primary fragmentation due to rotors, triggered by atrial stretch as seen by the relation of left atrial pressure and post CPVA-L FAE.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Issue number8
StatePublished - Dec 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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