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The Pathophysiology of Atrial Fibrillation

  • John Rawles

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).

Keywords

Atrial Fibrillation Refractory Period Paroxysmal Atrial Fibrillation Accessory Pathway Ventricular Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Aberg H (1969) Atrial fibrillation. II. A study of fibrillatory wave size on the regular scalar electrocardiogram. Acta Med Scand 185: 381–5PubMedCrossRefGoogle Scholar
  2. Aberg H, Strom G, Werner I (1972) Heart rate during exercise in patients with atrial fibrillation. Acta Med Scand 191: 315–20PubMedGoogle Scholar
  3. 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: 568–74PubMedCrossRefGoogle Scholar
  4. Akiyama T, Richeson JF, Faillace RT, Lockhart J, Scherer JC (1989) Ashman phenomenon of the T wave. Am J Cardiol 63: 886–90PubMedCrossRefGoogle Scholar
  5. Alessi R, Nusynowitz M, Abildskov JA, Moe GK (1958) Nonuniform distribution of vagal effects on the atrial refractory period. Am J Physiol 194: 406–10PubMedGoogle Scholar
  6. 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 44–61Google Scholar
  7. 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 112–30Google Scholar
  8. Altschule MD (1945) The relation between vagal activity and auricular fibrillation in various clinical conditions. New Eng J Med 233: 265–7CrossRefGoogle Scholar
  9. 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: 1097–1104PubMedGoogle Scholar
  10. 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: 1003–4PubMedCrossRefGoogle Scholar
  11. 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: 179–97PubMedCrossRefGoogle Scholar
  12. 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: 247–51PubMedCrossRefGoogle Scholar
  13. Bauernfeind RA, Wyndham CR, Swiryn SP, et al. (1981) Paroxysmal atrial fibrillation in the Wolff-Parkinson-White syndrome. Am J Cardiol 47: 562–9PubMedCrossRefGoogle Scholar
  14. Beasley R, Smith DA, McHaffie DJ (1985) Exercise heart rate at different serum digoxin concentrations in patients with atrial fibrillation. Br Med J 290: 9–11CrossRefGoogle Scholar
  15. Bennett MA, Pentecost BL (1970) The pattern of onset and spontaneous cessation of atrial fibrillation in man. Circulation 41: 981–8PubMedGoogle Scholar
  16. Bohn FK, Patterson DF, Pyle RL (1971) Atrial fibrillation in dogs. Br Vet J 127: 485–96PubMedGoogle Scholar
  17. 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: 783–94PubMedGoogle Scholar
  18. Borst C, Meijler FL (1984) Baroreflex modulation of ventricular rhythm in atrial fibrillation. Eur Heart J 5: 870–5PubMedGoogle Scholar
  19. Braunstein JR, Franke (1961) Autocorrelation of ventricular response in atrial fibrillation. Circ Res 9: 300–4Google Scholar
  20. 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: 45–54PubMedCrossRefGoogle Scholar
  21. Brody DA (1956) A theoretical analysis of intracavitary blood mass influence on the heart-lead relationship. Circ Res 4: 731–8PubMedGoogle Scholar
  22. Brody DA (1970) Ventricular rate patterns in atrial fibrillation. Circulation 41: 733–5PubMedGoogle Scholar
  23. Brugada P, Roy D, Weiss J, Dassen WR, Wellens HJ (1984) Dual atrioventricular nodal pathways and atrial fibrillation. PACE 7: 240–7PubMedGoogle Scholar
  24. Burn JH (1979) Excitatory actions of acetylcholine in the heart. Br J Pharmacol 67: 3–12PubMedGoogle Scholar
  25. Buxton AE, Josephson ME (1981) The role of P wave duration as a predictor of postoperative atrial arrhythmias. Chest 80: 68–73PubMedCrossRefGoogle Scholar
  26. Caceres CA, Calatayud JB, Nutter D, Kelser GA (1965) The intracavitary electrocardiogram of atrial fibrillation. Angiology 16: 584–93PubMedCrossRefGoogle Scholar
  27. Campbell RW, Smith RA, Gallagher JJ, Pritchett EL, Wallace AG (1977) Atrial fibrillation in the pre-excitation syndrome. Am J Cardiol 40: 514–20PubMedCrossRefGoogle Scholar
  28. 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: 811–16PubMedCrossRefGoogle Scholar
  29. Castellanos A, Levy S, Befeler B, Myerburg RJ (1975) Mechanisms determining the ventricular rate in Wolff-Parkinson-White arrhythmias. Adv Cardiol 14: 221–32PubMedGoogle Scholar
  30. Chamberlain DA, White RJ, Howard MR, Smith TW (1970) Plasma digoxin concentrations in patients with atrial fibrillation. Br Med J iii: 429–32CrossRefGoogle Scholar
  31. 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: 122–30PubMedCrossRefGoogle Scholar
  32. 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: 479–84PubMedCrossRefGoogle Scholar
  33. Cotoi S, Georgescu C, Kifor I (1979) Analysis of human atrial fibrillatory waves using monophasic action potential technique. Am Heart J 98: 465–71PubMedCrossRefGoogle Scholar
  34. Coumel P, Attuel P, Lavallee J, Flammang D, Leclercq JF, Slama R (1978) [The atrial arrhythmia syndrome of vagal origin] Arch Mal Coeur 71: 645–56PubMedGoogle Scholar
  35. 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: 80–5PubMedCrossRefGoogle Scholar
  36. Csapo G (1971) Role of ventricular premature beats in initiation and termination of atrial arrhythmias. Br Heart J 33: 105–10PubMedCrossRefGoogle Scholar
  37. Davies MJ, Pomerance A (1972) Pathology of atrial fibrillation in man. Br Heart J 34: 520–5PubMedCrossRefGoogle Scholar
  38. Demoulin J-C, Kulbertus HE (1979) Histopathological correlates of sinoatrial disease. Br Heart J 40: 1384–9CrossRefGoogle Scholar
  39. Dreifus LS, Mazgalev T (1988) “Atrial paralysis”: does it explain the irregular ventricular rate during atrial fibrillation? J Am Coll Cardiol 11: 546–7PubMedCrossRefGoogle Scholar
  40. 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: 31–8PubMedGoogle Scholar
  41. Euler DE, Scanion PJ (1987) Acetylcholine release by a stimulus train lowers atrial fibrillation threshold. Am J Physiol 253: H863–8PubMedGoogle Scholar
  42. 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: 38–46PubMedGoogle Scholar
  43. 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: 1168–74PubMedCrossRefGoogle Scholar
  44. 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: 1545–51Google Scholar
  45. 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 262–9Google Scholar
  46. Garber EB, Morgan MG, Glasser SP (1976) Left atrial size in patients with atrial fibrillation: an echocardiographic study. Am J Med Sei 272: 57–64CrossRefGoogle Scholar
  47. Gavrilescu S, Luca C (1975) Right atrium monophasic action potentials during atrial flutter and fibrillation in man. Am Heart J 90: 199–205PubMedCrossRefGoogle Scholar
  48. Gavrilescu S, Dragulescu SI, Streian C, Luca C (1976) Monophasic action potentials of the right atrium during atrial fibrillation in man. Cor Vasa 18: 264–70PubMedGoogle Scholar
  49. 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: 1203–6PubMedCrossRefGoogle Scholar
  50. Goldstein RE, Barnett GO (1967) A statistical study of the ventricular irregularity of atrial fibrillation. Comp Biomed Res 1: 146–61CrossRefGoogle Scholar
  51. Gordon S, Finck DR, Perera RD, Levine J, Barnes SJ (1984) Atrial infarction complicating an acute inferior myocardial infarction. Arch Intern Med 144: 193PubMedCrossRefGoogle Scholar
  52. Gouaux JL, Ashman R (1947) Auricular fibrillation with aberration simulating ventricular paroxysmal tachycardia. Am Heart J 34: 366–73PubMedCrossRefGoogle Scholar
  53. 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: 828–36PubMedCrossRefGoogle Scholar
  54. Gressard A, Atallah G, Chatelain MT, Touboul P (1981) [Genesis of auricular fibrillation in the Wolff-Parkinson-White syndrome]. Arch Mal Coeur 74: 1277–82PubMedGoogle Scholar
  55. 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: 41–50PubMedCrossRefGoogle Scholar
  56. 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: 1423–6Google Scholar
  57. 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: 1183–91PubMedGoogle Scholar
  58. 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: 175–81PubMedGoogle Scholar
  59. Henry WL, Morganroth J, Pearlman AS et al. (1976) Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53: 273–9PubMedGoogle Scholar
  60. Hering HE (1903) Analyse des pulsus irregularis perpetuus. Prag Med Wochenschr 28: 377–81Google Scholar
  61. 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: 146–50PubMedCrossRefGoogle Scholar
  62. Hodkinson HM, Pomerance A (1977) The clinical significance of senile cardiac amyloidosis: a prospective clinico-pathological study. Q J Med 46: 381–7PubMedGoogle Scholar
  63. Honzicova N, Fiser B, Semrad B (1973) Ventricular function in patients with atrial fibrillation. Cor Vasa 4: 257–64Google Scholar
  64. Horan LG, Kistler JC (1961) Study of ventricular response in atrial fibrillation. Circ Res 9: 305–11PubMedGoogle Scholar
  65. Ih S, Saitoh S (1982) The histopathological substratum for atrial fibrillation in man. Acta Pathol Jpn 32: 183–91PubMedGoogle Scholar
  66. James TN (1961) Myocardial infarction and atrial arrhythmias. Circulation 24: 761–76PubMedGoogle Scholar
  67. James TN (1968) The coronary circulation and conduction system in acute myocardial infarction. Prog Cardiovasc Dis 10: 410–49PubMedCrossRefGoogle Scholar
  68. 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 317–45Google Scholar
  69. James TN (1982) Diversity of histopathologic correlates of atrial fibrillation. In: Kulburtus HE, Olsson SB, Schlepper M (eds) Atrial fibrillation. AB Hassle, Molndal, pp 13–32Google Scholar
  70. 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: 1095–102PubMedCrossRefGoogle Scholar
  71. 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: 439–49PubMedGoogle Scholar
  72. Jose AD (1966) Effect of combined sympathetic and parasympathetic blockade on heart rate and cardiac function in man. Am J Cardiol 18: 476–78PubMedCrossRefGoogle Scholar
  73. Killip T, Gault JH (1965) Mode of onset of atrial fibrillation in man. Am Heart J 70: 172–9PubMedCrossRefGoogle Scholar
  74. Kirsh JA, Sahakian AV, Baerman JM, Swiryn S (1988) Ventricular response to atrial fibrillation: role of atrioventricular conduction pathways. J Am Coll Cardiol 12: 1265–72PubMedCrossRefGoogle Scholar
  75. Langendorf R, Pick A, Katz LN (1965) Ventricular response in atrial fibrillation. Role of concealed conduction in the AV junction. Circulation 32: 69–75PubMedGoogle Scholar
  76. Leier CV, Schaal SF (1980) Biatrial electrograms during coarse atrial fibrillation and flutter- fibrillation. Am Heart J 99: 331–41PubMedCrossRefGoogle Scholar
  77. Lepeschkin E (1951) Modern electrocardiography, vol 1. Williams & Wilkins, BaltimoreGoogle Scholar
  78. 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: 634–40PubMedGoogle Scholar
  79. Lewis T (1909) Auricular fibrillation: A common clinical condition. Br Med J ii: 1528CrossRefGoogle Scholar
  80. Lewis T (1909-10) Auricular fibrillation and its relationship to clinical irregularity of the heart. Heart 1:306–72Google Scholar
  81. Lewis T, Drury AN, Bulger HA (1921a) Observations upon flutter and fibrillation. VII. The effects of vagal stimulation. Heart 8: 141–70Google Scholar
  82. Lewis T, Drury AN, Wedd AM, Iliescu CC (1921b) Observations upon the action of certain drugs upon fibrillation of the auricles. Heart 9: 207–67Google Scholar
  83. Mackenzie J (1922) Observations on the process which results in auricular fibrillation. Br Med J ii: 71–3CrossRefGoogle Scholar
  84. 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: 1069–76PubMedCrossRefGoogle Scholar
  85. Mazgalev T, Dreifus LS, Bianchi J, Michelson EL (1982) Atrioventricular nodal conduction during atrial fibrillation in rabbit heart. Am J Physiol 243: H754–60PubMedGoogle Scholar
  86. Meijler FL (1986a) Comparative aspects of the dual role of the human atrioventricular node. Br Heart J 55: 286–90PubMedCrossRefGoogle Scholar
  87. Meijler FL (1986b) Editorial: the pulse in atrial fibrillation. Br Heart J 56: 1–3PubMedCrossRefGoogle Scholar
  88. 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: 316–23PubMedCrossRefGoogle Scholar
  89. Milstein S, Sharma AD, Klein GJ (1986) Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern. Am J Cardiol 57: 1097–100PubMedCrossRefGoogle Scholar
  90. Moe GK (1968) A conceptual model of atrial fibrillation. J Electrocardiol 1: 145–6PubMedCrossRefGoogle Scholar
  91. Moe GK, Abildskov JA (1964) Observations on the ventricular dysrhythmia associated with atrial fibrillation in the dog heart. Circ Res 14: 447–60PubMedGoogle Scholar
  92. Moore EN, Spear JF (1987) Electrophysiological studies on atrial fibrillation. Heart Vessels [Suppl] 2: 32–9Google Scholar
  93. 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: 184–6PubMedCrossRefGoogle Scholar
  94. 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: P428Google Scholar
  95. Nilius B, Schuttler K, Boldt W (1981) Parasympathetic influence on electrical vulnerability in the atrial myocardium of the rabbit. Acta Biol Med Ger 40: 821–9PubMedGoogle Scholar
  96. Ninomiya I (1966) Direct evidence of nonuniform distribution of vagal effects on dog atria. Circ Res 19: 576–83PubMedGoogle Scholar
  97. Olsson SB, Cotoi S, Varnauskas E (1971) Monophasic action potential and sinus rhythm stability after conversion of atrial fibrillation. Acta Med Scand 190: 381–7PubMedCrossRefGoogle Scholar
  98. 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: 320–33PubMedGoogle Scholar
  99. Pai GR, Rawles JM (1989) The QT interval in atrial fibrillation. Br Heart J 61: 510 - 3PubMedCrossRefGoogle Scholar
  100. Peter RH, Gracey JG, Beach TB (1968) Significance of fibrillatory waves and the P terminal force in idiopathic atrial fibrillation. Ann Intern Med 68: 1296–300PubMedGoogle Scholar
  101. Pitcher D, Papouchado M, James MA, Rees JR (1986) Twenty four hour ambulatory electrocardiography in patients with chronic atrial fibrillation. Br Med J 292: 594CrossRefGoogle Scholar
  102. 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 94–107Google Scholar
  103. Rawles JM, Rowland E (1986) Is the pulse in atrial fibrillation irregularly irregular? Br Heart J 56: 4–11PubMedCrossRefGoogle Scholar
  104. Rebello R, Brownlee WC (1987) Intermittent ventricular standstill during chronic atrial fibrillation in patients with dizziness or syncope. PACE 10: 1271–6PubMedGoogle Scholar
  105. 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: 473–81PubMedCrossRefGoogle Scholar
  106. Robitaille GA, Phillips JH (1967) An analysis of the P wave in patients with transient benign atrial fibrillation. Dis Chest 52: 806–12PubMedCrossRefGoogle Scholar
  107. Schamroth L (1969) The supernormal phase of intraventricular conduction. Br Heart J 31: 337–42PubMedCrossRefGoogle Scholar
  108. Scherf D (1947) Studies on auricular tachycardia caused by aconitine administration. Proc Soc Exp Bol Med 64: 233–9Google Scholar
  109. 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: 329–42PubMedCrossRefGoogle Scholar
  110. 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: 32–7PubMedCrossRefGoogle Scholar
  111. 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: 161–9PubMedCrossRefGoogle Scholar
  112. Shen EN, Sung RJ (1982) Initiation of atrial fibrillation by spontaneous ventricular premature beats in concealed Wolff- Parkinson-White syndrome. Am Heart J 103: 911–2PubMedCrossRefGoogle Scholar
  113. Simonson E, Cady LD, Woodbury M (1962) The normal Q-T interval. Am Heart J 63: 747–53PubMedCrossRefGoogle Scholar
  114. 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: 1080–90PubMedCrossRefGoogle Scholar
  115. 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: 96–108PubMedGoogle Scholar
  116. Soderstrom N (1950) What is the reason for the ventricular arrhythmia in cases of auricular fibrillation? Am Heart J 40: 212–23PubMedCrossRefGoogle Scholar
  117. 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
  118. Stewart GA, Fulton LJ, McKellar CD (1990) Idiopathic atrial fibrillation in a champion Standardbred racehorse. Aust Vet J 67: 187–91PubMedCrossRefGoogle Scholar
  119. Strackee J, Hoelen AJ, Zimmerman ANE, Meijler FL (1971) Artificial atrial fibrillation in the dog. An artifact? Circ Res 28: 441–5PubMedGoogle Scholar
  120. Takahashi N, Imataka K, Seki A, Fujii J (1982) Left atrial enlargement in patients with paroxysmal atrial fibrillation. Jpn Heart J 23: 677–83PubMedCrossRefGoogle Scholar
  121. Takahashi N, Seki A, Imataka K, Fujii J (1983) Fibrillatory wave size in paroxysmal atrial fibrillation. Jpn Heart J 24: 309–14PubMedCrossRefGoogle Scholar
  122. Teichmann W, Wanke R, Hecht P (1987) [Effect of ventricular filling volume on the R-amplitude in the ECG]. Z Gesamte Inn Med 42: 366–8PubMedGoogle Scholar
  123. Thiedemann KU, Ferrans VJ (1977) Left atrial ultrastructure in mitral valvular disease. Am J Pathol 89: 575–604PubMedGoogle Scholar
  124. 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: 563–9PubMedGoogle Scholar
  125. Urbach JR, Grauman JJ, Straus SH (1969) Quantititive methods for the recognition of atrioventricular junctional rhythms in atrial fibrillation. Circulation 39: 803–17PubMedGoogle Scholar
  126. 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: 1141–52PubMedCrossRefGoogle Scholar
  127. Waters DD, Nutter DO, Hopkins LC, Dorney ER (1975) Cardiac features of an unusual x-linked humeroperoneal neuromuscular disease. N Engl J Med 293: 1017–22PubMedCrossRefGoogle Scholar
  128. 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: 777–82CrossRefGoogle Scholar
  129. 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: 180–4PubMedCrossRefGoogle Scholar
  130. 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: 426–38PubMedGoogle Scholar
  131. Whittington JR, Cross MR, Raftery EB (1979) An effective conscious animal model of atrial fibrillation. Cardiovasc Res 13: 105–12PubMedCrossRefGoogle Scholar
  132. Wyndham CRC, Amat-y-Leon F, Wu D et al. (1977) Effects of cycle length on atrial vulnerability. Circulation 55: 260–7PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • John Rawles
    • 1
  1. 1.Department of Medicine and TherapeuticsUniversity of AberdeenAberdeenUK

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