Skip to main content

The Pathophysiology of Atrial Fibrillation

  • Chapter
Atrial Fibrillation

Abstract

Histological examination of the heart of a patient who has had chronic atrial fibrillation invariably shows abnormalities of the atria, the sinus node, and the region where they are contiguous (James 1982; Ih and Saitoh 1982). Patchy, focal degeneration and fibrosis of atrial myocardium and the conducting system are characteristic, and predispose to atrial fibrillation by virtue of the resulting inhomogeneity of refractoriness and repolarisation. Focal changes in the atria may result directly from involvement by inflammatory conditions such as rheumatic fever or sarcoidosis, or indirectly by occlusion of small arteries supplying the atria. The atrial myocardium may be patchily infiltrated with amyloid or tumour, or show reactive fibrosis as in haemachromatosis (Hodkinson and Pomerance 1977). Idiopathic focal degeneration of the atria, which may be very extensive, may also be seen, sometimes in several family members (Amat-Y-Leon et al. 1974; Waters et al. 1975).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Aberg H (1969) Atrial fibrillation. II. A study of fibrillatory wave size on the regular scalar electrocardiogram. Acta Med Scand 185: 381–5

    Article  PubMed  CAS  Google Scholar 

  • Aberg H, Strom G, Werner I (1972) Heart rate during exercise in patients with atrial fibrillation. Acta Med Scand 191: 315–20

    PubMed  CAS  Google Scholar 

  • Ahnve S (1985) Correction of the QT interval for heart rate: Review of different formulas and the use of Bazett’s formula in myocardial infarction. Am Heart J 109: 568–74

    Article  PubMed  CAS  Google Scholar 

  • Akiyama T, Richeson JF, Faillace RT, Lockhart J, Scherer JC (1989) Ashman phenomenon of the T wave. Am J Cardiol 63: 886–90

    Article  PubMed  CAS  Google Scholar 

  • Alessi R, Nusynowitz M, Abildskov JA, Moe GK (1958) Nonuniform distribution of vagal effects on the atrial refractory period. Am J Physiol 194: 406–10

    PubMed  CAS  Google Scholar 

  • Allessie MA, Lammers W, Smeets J, Bonke F, Hollen J (1982) Total mapping of atrial excitation during acetylcholine-induced atrial flutter and fibrillation in the isolated canine heart. In: Kulbertus HE, Olsson SB, Schlepper M (eds) Atrial fibrillation. AB Hassle, Molndal, pp 44–61

    Google Scholar 

  • Allessie MA, Rensma W, Brugada J, Smeets JLRM, Penn O, Kirchhof CJHJ (1990) Modes of atrial re-entry. In: Touboul P, Waldo AL (eds) Atrial arrhythmias. Current concepts and management. Mosby Year Book, St Louis, pp 112–30

    Google Scholar 

  • Altschule MD (1945) The relation between vagal activity and auricular fibrillation in various clinical conditions. New Eng J Med 233: 265–7

    Article  Google Scholar 

  • Amat-Y-Leon F, Racki AJ, Denes P et al. (1974) Familial atrial dysrhythmia with A-V block. Intracellular microelectrode, clinical electrophysiologic, and morphologic observations. Circulation 50: 1097–1104

    PubMed  CAS  Google Scholar 

  • Aronow WS, Schwartz KS, Koenigsberg M (1987). Prevalence of enlarged left atrial dimension by echocardiography and its correlation with atrial fibrillation and an abnormal P terminal force in lead VI of the electrocardiogram in 588 elderly persons. Am J Cardiol 59: 1003–4

    Article  PubMed  CAS  Google Scholar 

  • Attuel P, Childers R, Cauchemez B, Poveda J, Mugica J, Coumel P (1982) Failure in the rate adaptation of the atrial refractory period: its relationship to vulnerability. Int J Cardiol 2: 179–97

    Article  PubMed  CAS  Google Scholar 

  • Aysha MH, Hassan AS (1988) Diagnostic importance of fibrillatory wave amplitude: a clue to echocardiography left atrial size and etiology of atrial fibrillation. J Electrocardiol 21: 247–51

    Article  PubMed  CAS  Google Scholar 

  • Bauernfeind RA, Wyndham CR, Swiryn SP, et al. (1981) Paroxysmal atrial fibrillation in the Wolff-Parkinson-White syndrome. Am J Cardiol 47: 562–9

    Article  PubMed  CAS  Google Scholar 

  • Beasley R, Smith DA, McHaffie DJ (1985) Exercise heart rate at different serum digoxin concentrations in patients with atrial fibrillation. Br Med J 290: 9–11

    Article  CAS  Google Scholar 

  • Bennett MA, Pentecost BL (1970) The pattern of onset and spontaneous cessation of atrial fibrillation in man. Circulation 41: 981–8

    PubMed  CAS  Google Scholar 

  • Bohn FK, Patterson DF, Pyle RL (1971) Atrial fibrillation in dogs. Br Vet J 127: 485–96

    PubMed  CAS  Google Scholar 

  • Bootsma BK, Hoelen AJ, Strackee J, Meijler FL (1970) Analysis of R-R intervals in patients with atrial fibrillation at rest and during exercise. Circulation 41: 783–94

    PubMed  CAS  Google Scholar 

  • Borst C, Meijler FL (1984) Baroreflex modulation of ventricular rhythm in atrial fibrillation. Eur Heart J 5: 870–5

    PubMed  CAS  Google Scholar 

  • Braunstein JR, Franke (1961) Autocorrelation of ventricular response in atrial fibrillation. Circ Res 9: 300–4

    Google Scholar 

  • Brignole M, Menozzi C, Sartore B, Barra M, Monducci I (1986) The use of atrial pacing to induce atrial fibrillation and flutter. Int J Cardiol 12: 45–54

    Article  PubMed  CAS  Google Scholar 

  • Brody DA (1956) A theoretical analysis of intracavitary blood mass influence on the heart-lead relationship. Circ Res 4: 731–8

    PubMed  CAS  Google Scholar 

  • Brody DA (1970) Ventricular rate patterns in atrial fibrillation. Circulation 41: 733–5

    PubMed  CAS  Google Scholar 

  • Brugada P, Roy D, Weiss J, Dassen WR, Wellens HJ (1984) Dual atrioventricular nodal pathways and atrial fibrillation. PACE 7: 240–7

    PubMed  CAS  Google Scholar 

  • Burn JH (1979) Excitatory actions of acetylcholine in the heart. Br J Pharmacol 67: 3–12

    PubMed  CAS  Google Scholar 

  • Buxton AE, Josephson ME (1981) The role of P wave duration as a predictor of postoperative atrial arrhythmias. Chest 80: 68–73

    Article  PubMed  CAS  Google Scholar 

  • Caceres CA, Calatayud JB, Nutter D, Kelser GA (1965) The intracavitary electrocardiogram of atrial fibrillation. Angiology 16: 584–93

    Article  PubMed  CAS  Google Scholar 

  • Campbell RW, Smith RA, Gallagher JJ, Pritchett EL, Wallace AG (1977) Atrial fibrillation in the pre-excitation syndrome. Am J Cardiol 40: 514–20

    Article  PubMed  CAS  Google Scholar 

  • Castellanos A Jr, Myerburg RJ, Craparo K, Befeler B, Agha AS (1973) Factors regulating ventricular rates during atrial flutter and fibrillation in pre-excitation ( Wolff-Parkinson-White) syndrome. Br Heart J 35: 811–16

    Article  PubMed  Google Scholar 

  • Castellanos A, Levy S, Befeler B, Myerburg RJ (1975) Mechanisms determining the ventricular rate in Wolff-Parkinson-White arrhythmias. Adv Cardiol 14: 221–32

    PubMed  CAS  Google Scholar 

  • Chamberlain DA, White RJ, Howard MR, Smith TW (1970) Plasma digoxin concentrations in patients with atrial fibrillation. Br Med J iii: 429–32

    Article  Google Scholar 

  • Cosio FG, Palacios J, Vidal JM, Cocina EG, Gomez-Sanchez MA, Tamargo L (1983) Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: a possible manifestation of the background for re-entry. Am J Cardiol 51: 122–30

    Article  PubMed  CAS  Google Scholar 

  • Cotoi S, Carasca E, Georgescu C, Lazar P (1978) Two varieties of the onset of atrial fibrillation studied by monophasic action potential recording. Jpn Heart J 19: 479–84

    Article  PubMed  CAS  Google Scholar 

  • Cotoi S, Georgescu C, Kifor I (1979) Analysis of human atrial fibrillatory waves using monophasic action potential technique. Am Heart J 98: 465–71

    Article  PubMed  CAS  Google Scholar 

  • Coumel P, Attuel P, Lavallee J, Flammang D, Leclercq JF, Slama R (1978) [The atrial arrhythmia syndrome of vagal origin] Arch Mal Coeur 71: 645–56

    PubMed  CAS  Google Scholar 

  • Crick JC, Davies DW, Holt P, Curry PV, Sowton E (1985) Effect of exercise on ventricular response to atrial fibrillation in Wolff-Parkinson-White syndrome. Br Heart J 54: 80–5

    Article  PubMed  CAS  Google Scholar 

  • Csapo G (1971) Role of ventricular premature beats in initiation and termination of atrial arrhythmias. Br Heart J 33: 105–10

    Article  PubMed  CAS  Google Scholar 

  • Davies MJ, Pomerance A (1972) Pathology of atrial fibrillation in man. Br Heart J 34: 520–5

    Article  PubMed  CAS  Google Scholar 

  • Demoulin J-C, Kulbertus HE (1979) Histopathological correlates of sinoatrial disease. Br Heart J 40: 1384–9

    Article  Google Scholar 

  • Dreifus LS, Mazgalev T (1988) “Atrial paralysis”: does it explain the irregular ventricular rate during atrial fibrillation? J Am Coll Cardiol 11: 546–7

    Article  PubMed  CAS  Google Scholar 

  • Escudero EM, Iveli CA, Moreyra AE, Lorente H, Cingolani HE (1976) The pulse in patients with atrial fibrillation: its irregularity and inequality. Eur J Cardiol 4: 31–8

    PubMed  CAS  Google Scholar 

  • Euler DE, Scanion PJ (1987) Acetylcholine release by a stimulus train lowers atrial fibrillation threshold. Am J Physiol 253: H863–8

    PubMed  CAS  Google Scholar 

  • Farre J, Ross DL, Wiener I, Bar FW, Vanagt E, Wellens HJ (1979) Electrophysiological studies in patients with the Wolff- Parkinson-White syndrome. Herz 4: 38–46

    PubMed  CAS  Google Scholar 

  • Feldman T, Borow KM, Neumann A, Lang RM, Childers RW (1985) Relation of electrocardiographic R-wave amplitude to changes in left ventricular chamber size and position in normal subjects. Am J Cardiol 55: 1168–74

    Article  PubMed  CAS  Google Scholar 

  • Fromer M, Gloor H, Kappenberger L (1985) [Effect of heart rate on the refractory period of the accessory atrioventricular pathway in Wolff-Parkinson-White syndrome]. Schweiz Med Wochenschr 115: 1545–51

    Google Scholar 

  • Fujimura O, Klein GJ, Yee R, Sharma AD, Boahene KA (1990) Atrial fibrillation in the Wolff-Parkinson-White syndrome. In: Touboul P, Waldo AL (eds) Atrial arrhythmias. Current concepts and management. Mosby Year Book, St Louis, pp 262–9

    Google Scholar 

  • Garber EB, Morgan MG, Glasser SP (1976) Left atrial size in patients with atrial fibrillation: an echocardiographic study. Am J Med Sei 272: 57–64

    Article  CAS  Google Scholar 

  • Gavrilescu S, Luca C (1975) Right atrium monophasic action potentials during atrial flutter and fibrillation in man. Am Heart J 90: 199–205

    Article  PubMed  CAS  Google Scholar 

  • Gavrilescu S, Dragulescu SI, Streian C, Luca C (1976) Monophasic action potentials of the right atrium during atrial fibrillation in man. Cor Vasa 18: 264–70

    PubMed  CAS  Google Scholar 

  • German LD, Gallagher JJ, Broughton A, Guarnieri T, Trantham JL (1983) Effects of exercise and isoproterenol during atrial fibrillation in patients with Wolff-Parkinson-White syndrome. Am J Cardiol 51: 1203–6

    Article  PubMed  CAS  Google Scholar 

  • Goldstein RE, Barnett GO (1967) A statistical study of the ventricular irregularity of atrial fibrillation. Comp Biomed Res 1: 146–61

    Article  CAS  Google Scholar 

  • Gordon S, Finck DR, Perera RD, Levine J, Barnes SJ (1984) Atrial infarction complicating an acute inferior myocardial infarction. Arch Intern Med 144: 193

    Article  PubMed  CAS  Google Scholar 

  • Gouaux JL, Ashman R (1947) Auricular fibrillation with aberration simulating ventricular paroxysmal tachycardia. Am Heart J 34: 366–73

    Article  PubMed  CAS  Google Scholar 

  • Graybiel A (1964) Auricular fibrillation in an asymptomatic young man. Effects of exercise, digitalization, atropinization and the restoration of normal rhythm. Am J Cardiol 14: 828–36

    Article  PubMed  CAS  Google Scholar 

  • Gressard A, Atallah G, Chatelain MT, Touboul P (1981) [Genesis of auricular fibrillation in the Wolff-Parkinson-White syndrome]. Arch Mal Coeur 74: 1277–82

    PubMed  CAS  Google Scholar 

  • Gulamhusein S, Yee R, Ko PT, Klein GJ (1985) Electrocardiographic criteria for differentiating aberrancy and ventricular extrasystole in chronic atrial fibrillation: validation by intracardiac recordings. J Electrocardiol 18: 41–50

    Article  PubMed  CAS  Google Scholar 

  • Haft JI, Lau SH, Stein E, Kosowsky BD, Damato AN (1968) Atrial fibrillation produced by atrial stimulation. Circulation 37:70–4EP Hashida E, Inoue T, Tasaki T (1973) A probabilistic study of the irregularity of R-R interval durations in atrial fibrillation - a preliminary report. Jpn Circ J 37: 1423–6

    Google Scholar 

  • Hashimoto K, Chiba S, Tanaka S, Hirata M, Suzuki Y (1968) Adrenergic mechanism participating in induction of atrial fibrillation by ACh. Am J Physiol 215: 1183–91

    PubMed  CAS  Google Scholar 

  • Heimonas ET, Cokkinos DV, Hatzivasiloglou C, Papoulis S, Ioannou N, Chaniotakis M (1982) A study of the factors influencing the appearance of the Ashman phenomenon. Acta Cardiol 37: 175–81

    PubMed  CAS  Google Scholar 

  • Henry WL, Morganroth J, Pearlman AS et al. (1976) Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53: 273–9

    PubMed  CAS  Google Scholar 

  • Hering HE (1903) Analyse des pulsus irregularis perpetuus. Prag Med Wochenschr 28: 377–81

    Google Scholar 

  • Hod H, Lew AS, Keltai M et al. (1987) Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion. Circulation 75: 146–50

    Article  PubMed  CAS  Google Scholar 

  • Hodkinson HM, Pomerance A (1977) The clinical significance of senile cardiac amyloidosis: a prospective clinico-pathological study. Q J Med 46: 381–7

    PubMed  CAS  Google Scholar 

  • Honzicova N, Fiser B, Semrad B (1973) Ventricular function in patients with atrial fibrillation. Cor Vasa 4: 257–64

    Google Scholar 

  • Horan LG, Kistler JC (1961) Study of ventricular response in atrial fibrillation. Circ Res 9: 305–11

    PubMed  CAS  Google Scholar 

  • Ih S, Saitoh S (1982) The histopathological substratum for atrial fibrillation in man. Acta Pathol Jpn 32: 183–91

    PubMed  CAS  Google Scholar 

  • James TN (1961) Myocardial infarction and atrial arrhythmias. Circulation 24: 761–76

    PubMed  CAS  Google Scholar 

  • James TN (1968) The coronary circulation and conduction system in acute myocardial infarction. Prog Cardiovasc Dis 10: 410–49

    Article  PubMed  CAS  Google Scholar 

  • James TN (1980) Neural control of the heart in health and disease. In: Stollerman GH (ed) Advances in internal medicine, vol 26. Year Book Medical Publishers, Chicago, pp 317–45

    Google Scholar 

  • James TN (1982) Diversity of histopathologic correlates of atrial fibrillation. In: Kulburtus HE, Olsson SB, Schlepper M (eds) Atrial fibrillation. AB Hassle, Molndal, pp 13–32

    Google Scholar 

  • James TN, Pearce WN, Givhan EG (1980) Sudden death while driving. Role of sinus perinodal degeneration and cardiac neural degeneration and ganglionitis. Am J Cardiol 45: 1095–102

    Article  PubMed  CAS  Google Scholar 

  • Janse MJ (1969) Influence of the direction of the atrial wave front on A-V nodal transmission in isolated hearts of rabbits. Circ Res 25: 439–49

    PubMed  CAS  Google Scholar 

  • Jose AD (1966) Effect of combined sympathetic and parasympathetic blockade on heart rate and cardiac function in man. Am J Cardiol 18: 476–78

    Article  PubMed  CAS  Google Scholar 

  • Killip T, Gault JH (1965) Mode of onset of atrial fibrillation in man. Am Heart J 70: 172–9

    Article  PubMed  CAS  Google Scholar 

  • Kirsh JA, Sahakian AV, Baerman JM, Swiryn S (1988) Ventricular response to atrial fibrillation: role of atrioventricular conduction pathways. J Am Coll Cardiol 12: 1265–72

    Article  PubMed  CAS  Google Scholar 

  • Langendorf R, Pick A, Katz LN (1965) Ventricular response in atrial fibrillation. Role of concealed conduction in the AV junction. Circulation 32: 69–75

    PubMed  CAS  Google Scholar 

  • Leier CV, Schaal SF (1980) Biatrial electrograms during coarse atrial fibrillation and flutter- fibrillation. Am Heart J 99: 331–41

    Article  PubMed  CAS  Google Scholar 

  • Lepeschkin E (1951) Modern electrocardiography, vol 1. Williams & Wilkins, Baltimore

    Google Scholar 

  • Levy S, Broustet JP, Clementy J, Vircoulon B, Guern P, Bricaud H (1979) [Wolff-Parkinson-White syndrome. Correlation between the results of electrophysiological investigation and exercise tolerance testing on the electrical aspect of pre-excitation] Arch Mal Coeur 72: 634–40

    PubMed  CAS  Google Scholar 

  • Lewis T (1909) Auricular fibrillation: A common clinical condition. Br Med J ii: 1528

    Article  Google Scholar 

  • Lewis T (1909-10) Auricular fibrillation and its relationship to clinical irregularity of the heart. Heart 1:306–72

    Google Scholar 

  • Lewis T, Drury AN, Bulger HA (1921a) Observations upon flutter and fibrillation. VII. The effects of vagal stimulation. Heart 8: 141–70

    Google Scholar 

  • Lewis T, Drury AN, Wedd AM, Iliescu CC (1921b) Observations upon the action of certain drugs upon fibrillation of the auricles. Heart 9: 207–67

    Google Scholar 

  • Mackenzie J (1922) Observations on the process which results in auricular fibrillation. Br Med J ii: 71–3

    Article  Google Scholar 

  • Manyari DE, Patterson C, Johnson D, Melendez L, Kostuk WJ, Cape RDT (1990) Atrial and ventricular arrhythmias in asymptomatic active elderly subjects: Correlation with left atrial size and left ventricular mass. Am Heart J 119: 1069–76

    Article  PubMed  CAS  Google Scholar 

  • Mazgalev T, Dreifus LS, Bianchi J, Michelson EL (1982) Atrioventricular nodal conduction during atrial fibrillation in rabbit heart. Am J Physiol 243: H754–60

    PubMed  CAS  Google Scholar 

  • Meijler FL (1986a) Comparative aspects of the dual role of the human atrioventricular node. Br Heart J 55: 286–90

    Article  PubMed  CAS  Google Scholar 

  • Meijler FL (1986b) Editorial: the pulse in atrial fibrillation. Br Heart J 56: 1–3

    Article  PubMed  CAS  Google Scholar 

  • Meijler FL, Kroneman J, Tweel I van der, Herbscleb JN, Heethar RM, Borst C (1984) Nonrandom ventricular rhythm in horses with atrial fibrillation and its significance for patients. J Am Coll Cardiol 4: 316–23

    Article  PubMed  CAS  Google Scholar 

  • Milstein S, Sharma AD, Klein GJ (1986) Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern. Am J Cardiol 57: 1097–100

    Article  PubMed  CAS  Google Scholar 

  • Moe GK (1968) A conceptual model of atrial fibrillation. J Electrocardiol 1: 145–6

    Article  PubMed  CAS  Google Scholar 

  • Moe GK, Abildskov JA (1964) Observations on the ventricular dysrhythmia associated with atrial fibrillation in the dog heart. Circ Res 14: 447–60

    PubMed  CAS  Google Scholar 

  • Moore EN, Spear JF (1987) Electrophysiological studies on atrial fibrillation. Heart Vessels [Suppl] 2: 32–9

    CAS  Google Scholar 

  • Morganroth J, Horowitz LN, Josephson ME, Kastor JA (1979) Relationship of atrial fibrillatory wave amplitude to left atrial size and etiology of heart disease. An old generalization re-examined. Am Heart J 97: 184–6

    Article  PubMed  CAS  Google Scholar 

  • Nahum LH, Hoff HE (1940) Production of auricular fibrillation by application of acetyl-beta-methylcholine chloride to localized region on the auricular surface. Am J Physiol 129: P428

    Google Scholar 

  • Nilius B, Schuttler K, Boldt W (1981) Parasympathetic influence on electrical vulnerability in the atrial myocardium of the rabbit. Acta Biol Med Ger 40: 821–9

    PubMed  CAS  Google Scholar 

  • Ninomiya I (1966) Direct evidence of nonuniform distribution of vagal effects on dog atria. Circ Res 19: 576–83

    PubMed  CAS  Google Scholar 

  • Olsson SB, Cotoi S, Varnauskas E (1971) Monophasic action potential and sinus rhythm stability after conversion of atrial fibrillation. Acta Med Scand 190: 381–7

    Article  PubMed  CAS  Google Scholar 

  • Olsson SB, Cai N, Dohnal M, Talwar KK (1986) Noninvasive support for and characterization of multiple intranodal pathways in patients with mitral valve disease and atrial fibrillation. Eur Heart J 7: 320–33

    PubMed  CAS  Google Scholar 

  • Pai GR, Rawles JM (1989) The QT interval in atrial fibrillation. Br Heart J 61: 510 - 3

    Article  PubMed  CAS  Google Scholar 

  • Peter RH, Gracey JG, Beach TB (1968) Significance of fibrillatory waves and the P terminal force in idiopathic atrial fibrillation. Ann Intern Med 68: 1296–300

    PubMed  CAS  Google Scholar 

  • Pitcher D, Papouchado M, James MA, Rees JR (1986) Twenty four hour ambulatory electrocardiography in patients with chronic atrial fibrillation. Br Med J 292: 594

    Article  CAS  Google Scholar 

  • Puech P, Grolleau R, Rebuffat G (1982) Intra-atrial mapping of atrial fibrillation in man. In: Kulburtus HE, Olsson SB, Schlepper M (eds) Atrial fibrillation. AB Hassle, Molndal, pp 94–107

    Google Scholar 

  • Rawles JM, Rowland E (1986) Is the pulse in atrial fibrillation irregularly irregular? Br Heart J 56: 4–11

    Article  PubMed  CAS  Google Scholar 

  • Rebello R, Brownlee WC (1987) Intermittent ventricular standstill during chronic atrial fibrillation in patients with dizziness or syncope. PACE 10: 1271–6

    PubMed  CAS  Google Scholar 

  • Reynolds EW, MacDonald WJ, Greenfield BM, Semion AA (1967) Mechanisms of onset and termination of abnormal cardiac rhythm studied by constant monitoring. Am Heart J 74: 473–81

    Article  PubMed  Google Scholar 

  • Robitaille GA, Phillips JH (1967) An analysis of the P wave in patients with transient benign atrial fibrillation. Dis Chest 52: 806–12

    Article  PubMed  CAS  Google Scholar 

  • Schamroth L (1969) The supernormal phase of intraventricular conduction. Br Heart J 31: 337–42

    Article  PubMed  CAS  Google Scholar 

  • Scherf D (1947) Studies on auricular tachycardia caused by aconitine administration. Proc Soc Exp Bol Med 64: 233–9

    CAS  Google Scholar 

  • Schlamowitz I (1946) An analysis of the time relationships within the cardiac cycle in electrocardiograms of normal men. I. The duration of the Q-T interval and its relationship to the cycle length (R- R interval). Am Heart J 31: 329–42

    Article  PubMed  CAS  Google Scholar 

  • Seed WA, Noble MIM, Oldershaw P et al. (1987) Relation of human cardiac action potential duration to the interval between beats: implications for the validity of rate corrected QT interval ( QTc ). Br Heart J 57: 32–7

    Article  PubMed  CAS  Google Scholar 

  • Sharma AD, Klein GJ, Guiraudon GM, Milstein S (1985) Atrial fibrillation in patients with Wolff- Parkinson-White syndrome: incidence after surgical ablation of the accessory pathway. Circulation 72: 161–9

    Article  PubMed  CAS  Google Scholar 

  • Shen EN, Sung RJ (1982) Initiation of atrial fibrillation by spontaneous ventricular premature beats in concealed Wolff- Parkinson-White syndrome. Am Heart J 103: 911–2

    Article  PubMed  CAS  Google Scholar 

  • Simonson E, Cady LD, Woodbury M (1962) The normal Q-T interval. Am Heart J 63: 747–53

    Article  PubMed  CAS  Google Scholar 

  • Simpson RJ Jr, Amara I, Foster JR, Woelfel A, Gettes LS (1988) Thresholds, refractory periods, and conduction times of the normal and diseased human atrium. Am Heart J 116: 1080–90

    Article  PubMed  Google Scholar 

  • Smeets JLRM, Allessie MA, Lammers WJEP, Bonke FIM, Hollen J (1986) The wavelength of the cardiac impulse and re-entrant arrhythmias in isolated rabbit atrium. The role of heart rate, autonomic transmitters, temperature, and potassium. Circ Res 58: 96–108

    PubMed  CAS  Google Scholar 

  • Soderstrom N (1950) What is the reason for the ventricular arrhythmia in cases of auricular fibrillation? Am Heart J 40: 212–23

    Article  PubMed  CAS  Google Scholar 

  • Stafford P, Turner I, Vincent R (1990) Quantitative analysis of the P wave in paroxysmal atrial fibrillation. Br Heart J 64: 87 (abstract)

    Google Scholar 

  • Stewart GA, Fulton LJ, McKellar CD (1990) Idiopathic atrial fibrillation in a champion Standardbred racehorse. Aust Vet J 67: 187–91

    Article  PubMed  CAS  Google Scholar 

  • Strackee J, Hoelen AJ, Zimmerman ANE, Meijler FL (1971) Artificial atrial fibrillation in the dog. An artifact? Circ Res 28: 441–5

    PubMed  CAS  Google Scholar 

  • Takahashi N, Imataka K, Seki A, Fujii J (1982) Left atrial enlargement in patients with paroxysmal atrial fibrillation. Jpn Heart J 23: 677–83

    Article  PubMed  CAS  Google Scholar 

  • Takahashi N, Seki A, Imataka K, Fujii J (1983) Fibrillatory wave size in paroxysmal atrial fibrillation. Jpn Heart J 24: 309–14

    Article  PubMed  CAS  Google Scholar 

  • Teichmann W, Wanke R, Hecht P (1987) [Effect of ventricular filling volume on the R-amplitude in the ECG]. Z Gesamte Inn Med 42: 366–8

    PubMed  CAS  Google Scholar 

  • Thiedemann KU, Ferrans VJ (1977) Left atrial ultrastructure in mitral valvular disease. Am J Pathol 89: 575–604

    PubMed  CAS  Google Scholar 

  • Tonkin AM, Miller HC, Svenson RH, Wallace AG, Gallagher JJ (1975) Refractory periods of the accessory pathway in the Wolff-Parkinson-White syndrome. Circulation 52: 563–9

    PubMed  CAS  Google Scholar 

  • Urbach JR, Grauman JJ, Straus SH (1969) Quantititive methods for the recognition of atrioventricular junctional rhythms in atrial fibrillation. Circulation 39: 803–17

    PubMed  CAS  Google Scholar 

  • Waspe LE, Brodman R, Kim SG, Fisher JD (1986) Susceptibility to atrial fibrillation and ventricular tachyarrhythmia in the Wolff-Parkinson-White syndrome: role of the accessory pathway. Am Heart J 112: 1141–52

    Article  PubMed  CAS  Google Scholar 

  • Waters DD, Nutter DO, Hopkins LC, Dorney ER (1975) Cardiac features of an unusual x-linked humeroperoneal neuromuscular disease. N Engl J Med 293: 1017–22

    Article  PubMed  CAS  Google Scholar 

  • Wellens HJ, Durrer D (1974) Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol 34: 777–82

    Article  Google Scholar 

  • Wellens HJ, Brugada P, Roy D, Weiss J, Bar FW (1982) Effect of isoproterenol on the anterograde refractory period of the accessory pathway in patients with the Wolff-Parkinson-White syndrome. Am J Cardiol 50: 180–4

    Article  PubMed  CAS  Google Scholar 

  • Wells JL, Karp RB, Kouchoukos NT, MacLean WA, James TN, Waldo AL (1978) Characterization of atrial fibrillation in man: studies following open heart surgery. PACE 1: 426–38

    PubMed  Google Scholar 

  • Whittington JR, Cross MR, Raftery EB (1979) An effective conscious animal model of atrial fibrillation. Cardiovasc Res 13: 105–12

    Article  PubMed  CAS  Google Scholar 

  • Wyndham CRC, Amat-y-Leon F, Wu D et al. (1977) Effects of cycle length on atrial vulnerability. Circulation 55: 260–7

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 1992 Springer-Verlag London Limited

About this chapter

Cite this chapter

Rawles, J. (1992). The Pathophysiology of Atrial Fibrillation. In: Atrial Fibrillation. Springer, London. https://doi.org/10.1007/978-1-4471-1898-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-1898-5_2

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1900-5

  • Online ISBN: 978-1-4471-1898-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics