Recording atrial monophasic action potentials using standard pacemaker leads: an alternative way to study electrophysiology properties of the human atrium in vivo?

AF leads to electrophysiological changes, but it is not known if similar alterations also appear before the onset of the first episode of AF because invasive electrophysiological studies are not justified in otherwise symptom-free patients. To address this question requires a safe method of obtaining atrial electrophysiological parameters at no extra risk or discomfort for the patient. The aim of this study was to test if recording of monophasic action potentials (MAPs) is feasible during pacemaker implantation. The study included 22 patients undergoing pacemaker implantation for symptomatic bradycardia without any history of AF. Using a custommade amplifier and a minor modification of the routine procedure for intraoperatively measured P waves, atrial electrograms could be recorded using a standard active pacemaker lead. MAP-like electrograms were obtained in 15 patients. MAP amplitude was 2.6 +/- 0.3 mV, mean action potential duration was 316 +/- 12 ms at a spontaneous heart rate of 67.2 +/- 3.2 beats/min. MAP duration was decreased when atria were stimulated at shorter cycle lengths (249 +/- 12 ms at 150 beats/min, P <0.05 vs sinus rhythm). In about two thirds of patients undergoing pacemaker implantation, recording of MAP-like electrograms was feasible with only minor modification of the atrial electrogram recording technique. The method should allow screening patients for electrophysiological alterations even before the onset of AF.