Atrial electrical and structural changes associated with longstanding hypertension in humans: Implications for the substrate for atrial fibrillation

Caroline Medi, Jonathan M. Kalman, Steven J Spence, Andrew W. Teh, Geoffrey Lee, Ilona Bader, David M. Kaye, Peter M Kistler

Research output: Contribution to journalArticleResearchpeer-review

81 Citations (Scopus)


Introduction: Hypertension (HT) is the most common modifiable risk factor for atrial fibrillation (AF), yet little is known of the atrial effects of chronic HT in humans. We aimed to characterize the electrophysiologic (EP) and electroanatomic (EA) remodeling of the right atrium (RA) in patients with chronically treated systemic HT and left ventricular hypertrophy (LVH) without a history of AF. Methods and Results: Twenty patients with (systolic BP 145 ± 10 mmHg) and without (BP 119 ± 11 mmHg, P < 0.01) systemic HT underwent detailed conventional EP and EA voltage and activation mapping. We measured RA refractoriness at the coronary sinus and high septum at cycle lengths (CLs) 600 and 450 ms, and RA conduction velocities, activation times, and voltages at a global and regional level at CLs 600 ms and 300 ms. HT was associated with slowing of global (73 ± 17 cm/s vs 96 ± 12 cm/s in controls, P < 0.01) and regional conduction velocity particularly in the posterior RA (70 ± 17 cm/s vs 96 ± 12 cm/s in controls, P < 0.01) at the crista terminalis (fractionation and double potentials in HT 72%± 4 vs 43%± 23 in controls, P = 0.04). Mean RA voltage was similar between the 2 groups, however HT was associated with an increase in areas of low voltage (<0.5 mV; HT 13% vs controls 9%, P = 0.04). Sustained AF was induced in 30% HT patients and no controls. Conclusion: Chronically treated systemic HT with LVH is accompanied by atrial remodeling characterized by: (i) global conduction slowing, (ii) regional conduction delay particularly at the crista terminalis, and (iii) increased AF inducibility. These changes may in part be responsible for the increased propensity to AF associated with systemic HT.

Original languageEnglish
Pages (from-to)1317-1324
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Issue number12
Publication statusPublished - Dec 2011
Externally publishedYes


  • atrial fibrillation
  • blood pressure
  • catheter ablation
  • hypertension
  • hypertrophy
  • remodeling
  • supraventricular
  • tachycardia

Cite this