This human case is the first to illustrate morphological manifestations of direction- and rate-dependent anisotropic conduction in high-resolution unipolar atrial potentials. Premature impulses induced low-amplitude, fractionated extracellular potentials with exceptionally prolonged durations in a 76-year old longstanding persistent patient with atrial fibrillation (AF), demonstrating direction-dependency of anisotropic conduction. An increased pacing frequency induced presence of similar fractionated potentials, reflecting rate-dependent anisotropy and inhomogeneous, slow conduction. Pacing with different rates and from different sites could aid in identifying nonuniform anisotropic tissue and thus the substrate of AF.

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Keywords anisotropy, atrial fibrillation, direction-dependency, fractionation, rate-dependency, surgical ablation
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Journal Journal of Cardiovascular Electrophysiology
Organisation Department of Cardiology
Starreveld, R. (Roeliene), & de Groot, N.M.S. (2020). Direction- and rate-dependent fractionation during atrial fibrillation persistence: Unmasking cardiac anisotropy?. Journal of Cardiovascular Electrophysiology. doi:10.1111/jce.14597