{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T09:47:58Z","timestamp":1777196878870,"version":"3.51.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NWO-Vidi","award":["91717339"],"award-info":[{"award-number":["91717339"]}]},{"DOI":"10.13039\/100007497","name":"Biosense Webster","doi-asserted-by":"crossref","award":["ICD 783454"],"award-info":[{"award-number":["ICD 783454"]}],"id":[{"id":"10.13039\/100007497","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Loss of cell-to-cell communication results in local conduction disorders and directional heterogeneity (LDH) in conduction velocity (CV) vectors, which may be unmasked by premature atrial contractions (PACs). We quantified LDH and examined differences between sinus rhythm (SR) and spontaneous PACs in patients with and without atrial fibrillation (AF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Intra-operative epicardial mapping of the right and left atrium (RA, LA), Bachmann\u2019s bundle (BB) and pulmonary vein area (PVA) was performed in 228 patients (54 with AF). Conduction velocity vectors were computed at each electrode using discrete velocity vectors. Directions and magnitudes of individual vectors were compared with surrounding vectors to identify LDH. Five hundred and three PACs [2 (1\u20133) per patient; prematurity index of 45 \u00b1 12%] were included. During SR, most LDH were found at BB and LA [11.9 (8.3\u201314.9) % and 11.3 (8.0\u201315.2) %] and CV was lowest at BB [83.5 (72.4\u201394.3) cm\/s, all P &amp;lt; 0.05]. Compared with SR, the largest increase in LDH during PAC was found at BB and PVA [+13.0 (7.7, 18.3) % and +12.5 (10.8, 14.2) %, P &amp;lt; 0.001]; CV decreased particularly at BB, PVA and LA [\u221210.0 (\u221213.2, \u22126.9) cm\/s, \u22129.3 (\u221212.5, \u22126.2) cm\/s and \u22129.1 (\u221211.7, \u22126.6) cm\/s, P &amp;lt; 0.001]. Comparing patients with and without AF, more LDH were found during SR in AF patients at PVA and BB, although the increase in LDH during PACs was similar for all sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Local directional heterogeneity is a novel methodology to quantify local heterogeneity in CV as a possible indicator of electropathology. Intra-operative high-resolution mapping indeed revealed that LDH increased during PACs particularly at BB and PVA. Also, patients with AF already have more LDH during SR, which becomes more pronounced during PACs.<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euac283","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T22:29:40Z","timestamp":1673648980000},"page":"1162-1171","source":"Crossref","is-referenced-by-count":11,"title":["Premature atrial contractions promote local directional heterogeneities in conduction velocity vectors"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-5465","authenticated-orcid":false,"given":"Mathijs S","family":"van Schie","sequence":"first","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4992-2802","authenticated-orcid":false,"given":"Nawin L","family":"Ramdat Misier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-8809","authenticated-orcid":false,"given":"Payam","family":"Razavi Ebrahimi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annejet","family":"Heida","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7671-4542","authenticated-orcid":false,"given":"Rohit K","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"},{"name":"Department of Cardiothoracic Surgery, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick J H J","family":"Taverne","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-2455","authenticated-orcid":false,"given":"Natasja M S","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Dr. Molewaterplein 40, 3015GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"key":"2023033021232078400_","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1152\/physrev.00025.2003","article-title":"Basic mechanisms of cardiac impulse propagation and associated arrhythmias","volume":"84","author":"Kleber","year":"2004","journal-title":"Physiol Rev"},{"key":"2023033021232078400_","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/01.RES.58.3.356","article-title":"Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. 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