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

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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

Original languageEnglish
Pages (from-to)227-237
Number of pages11
JournalJournal of Interventional Cardiac Electrophysiology
Issue number1
Accepted/In press2022
PublishedOct 2022

Bibliographical 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: © 2022, The Author(s).

King's Authors


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.

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