Provocation and localization of atrial ectopy in patients with atrial septal defects

Louisa O’Neill; Iain Sim; Daniel O’Hare; John Whitaker; Rahul K. Mukherjee; Steven Niederer; Matthew Wright; Vivienne Ezzat; Eric Rosenthal; Matthew I. Jones; Alessandra Frigiola; Mark D. O’Neill; Steven E. Williams

doi:10.1007/s10840-022-01273-2

Provocation and localization of atrial ectopy in patients with atrial septal defects

Louisa O’Neill^*, Iain Sim, Daniel O’Hare, John Whitaker, Rahul K. Mukherjee, Steven Niederer, Matthew Wright, Vivienne Ezzat, Eric Rosenthal, Matthew I. Jones, Alessandra Frigiola, Mark D. O’Neill, Steven E. Williams

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods: Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results: Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions: When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.

Original language	English
Pages (from-to)	227-237
Number of pages	11
Journal	Journal of Interventional Cardiac Electrophysiology
Volume	65
Issue number	1
DOIs	https://doi.org/10.1007/s10840-022-01273-2
Publication status	Published - Oct 2022

Keywords

Atrial arrhythmia
Atrial ectopy
Atrial septal defect
Right atrium

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10.1007/s10840-022-01273-2

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O’Neill, L., Sim, I., O’Hare, D., Whitaker, J., Mukherjee, R. K., Niederer, S., Wright, M., Ezzat, V., Rosenthal, E., Jones, M. I., Frigiola, A., O’Neill, M. D., & Williams, S. E. (2022). Provocation and localization of atrial ectopy in patients with atrial septal defects. Journal of Interventional Cardiac Electrophysiology, 65(1), 227-237. https://doi.org/10.1007/s10840-022-01273-2

@article{53bc669be19d4a56bfcbe09512e714e7,

title = "Provocation and localization of atrial ectopy in patients with atrial septal defects",

abstract = "Background: Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods: Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results: Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions: When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.",

keywords = "Atrial arrhythmia, Atrial ectopy, Atrial septal defect, Right atrium",

author = "Louisa O{\textquoteright}Neill and Iain Sim and Daniel O{\textquoteright}Hare and John Whitaker and Mukherjee, {Rahul K.} and Steven Niederer and Matthew Wright and Vivienne Ezzat and Eric Rosenthal and Jones, {Matthew I.} and Alessandra Frigiola and O{\textquoteright}Neill, {Mark D.} and Williams, {Steven E.}",

note = "Funding Information: This work was supported by Guangdong Basic and Applied Basic Research Foundation (Grant Number: 2021A1515010665, 2020A1515010088), National Natural Science Foundation of China (Grant Numbers: 81902479, 81874074, 82072705), China Postdoctoral Science Foundation (Grant Number: 2019 M652961), Natural Science Foundation of the Anhui provincial High-Education Institutions of China (Grant Numbers: KJ2021A0828), Key Scientific Research Foundation of the Wannan Medical College (Grant Number: WK2020Z01). Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = oct,

doi = "10.1007/s10840-022-01273-2",

language = "English",

volume = "65",

pages = "227--237",

journal = "Journal of Interventional Cardiac Electrophysiology",

issn = "1383-875X",

publisher = "Springer",

number = "1",

}

O’Neill, L, Sim, I, O’Hare, D, Whitaker, J, Mukherjee, RK, Niederer, S, Wright, M, Ezzat, V, Rosenthal, E, Jones, MI, Frigiola, A, O’Neill, MD & Williams, SE 2022, 'Provocation and localization of atrial ectopy in patients with atrial septal defects', Journal of Interventional Cardiac Electrophysiology, vol. 65, no. 1, pp. 227-237. https://doi.org/10.1007/s10840-022-01273-2

TY - JOUR

T1 - Provocation and localization of atrial ectopy in patients with atrial septal defects

AU - O’Neill, Louisa

AU - Sim, Iain

AU - O’Hare, Daniel

AU - Whitaker, John

AU - Mukherjee, Rahul K.

AU - Niederer, Steven

AU - Wright, Matthew

AU - Ezzat, Vivienne

AU - Rosenthal, Eric

AU - Jones, Matthew I.

AU - Frigiola, Alessandra

AU - O’Neill, Mark D.

AU - Williams, Steven E.

N1 - Funding Information: This work was supported by Guangdong Basic and Applied Basic Research Foundation (Grant Number: 2021A1515010665, 2020A1515010088), National Natural Science Foundation of China (Grant Numbers: 81902479, 81874074, 82072705), China Postdoctoral Science Foundation (Grant Number: 2019 M652961), Natural Science Foundation of the Anhui provincial High-Education Institutions of China (Grant Numbers: KJ2021A0828), Key Scientific Research Foundation of the Wannan Medical College (Grant Number: WK2020Z01). Publisher Copyright: © 2022, The Author(s).

PY - 2022/10

Y1 - 2022/10

N2 - Background: Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods: Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results: Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions: When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.

AB - Background: Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods: Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results: Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions: When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.

KW - Atrial arrhythmia

KW - Atrial ectopy

KW - Atrial septal defect

KW - Right atrium

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U2 - 10.1007/s10840-022-01273-2

DO - 10.1007/s10840-022-01273-2

M3 - Article

AN - SCOPUS:85132582128

SN - 1383-875X

VL - 65

SP - 227

EP - 237

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

IS - 1

ER -

Provocation and localization of atrial ectopy in patients with atrial septal defects

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