Direction-dependent conduction in lone atrial fibrillation

Background Patients with lone atrial fibrillation (AF) have an abnormal atrial substrate. Objective The purpose of this study was to determine the role of direction-dependent conduction in patients with lone AF. Methods Twenty-four patients with paroxysmal lone AF and 24 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium, crista terminalis, coronary sinus (CS), and left atrial roof were used to determine direction-dependent conduction characteristics. Biatrial electroanatomic maps were created during sinus rhythm and with distal CS pacing to characterize direction-dependent differences in conduction velocities, electrogram complexity, and voltage. Results Differing wavefront directions caused changes in conduction velocity ( P