Epicardial Ablation of Rotors Suppresses Inducibility of Acetylcholine-Induced Atrial Fibrillation in Left Pulmonary Vein-Left Atrium Preparations in a Beagle Heart Failure Model
Epicardial Ablation of Rotors Suppresses Inducibility of Acetylcholine-Induced Atrial Fibrillation in Left Pulmonary Vein-Left Atrium Preparations in a Beagle Heart Failure Model
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DOI：
10.1016/j.jacc.2011.02.045
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发表时间：
2011-07-05
影响因子：
24
通讯作者：
Wu, Delon
中科院分区：
文献类型：
--
作者：
Chou, Chung-Chuan;Chang, Po-Cheng;Wu, Delon
目的为转子消融抑制心房颤动（AF）的诱发提供直接证据。背景微折返波阵面被认为是AF时快速激动的来源。转子消融是否抑制AF的诱发尚不清楚。方法应用光学标测技术研究Langendorff灌注的左肺静脉（PV）-左心房（LA）。来自13只患有起搏诱导的心力衰竭的狗的制剂。起搏诱发心房心律失常，并在乙酰胆碱输注（1 μ mol/l）期间标测。从光学记录中识别转子。在持续性（>10 min）或持续性自发性AF的准备中，针对转子锚定部位进行心外膜消融。在4例准备中进行非转子消融。结果12例患者经静脉注射乙酰胆碱后诱发持续性房颤，1例诱发持续性自发性房颤。9例标本中发现肺静脉局灶性放电（9.2 +/- 4.2次/秒），13例标本中在左上级肺静脉-左心房连接处发现转子锚定（9.1 +/- 4.6次/秒），1例标本中在Marshall-肺静脉-左心房连接处韧带发现转子锚定。心外膜转子消融成功地抑制了13例标本中12例持续性AF的诱发（p < 0.01），包括4例最大主频部位位于肺静脉-左心房交界转子区（直接消除母转子）。转子消融显著缩短了最长房颤持续时间（Wilcoxon Z = 3.60，p = 0.002，n = 13），而非转子消融无显著缩短（Wilcoxon Z = 1.00，p = 0.317，n = 4）。转子消融直接/间接抑制了最大主频部位的致心律失常性。（J Am科尔心脏病学杂志2011;58：158-66）（C）美国心脏病学会基金会2011年
Objectives The purpose of this study was to provide direct evidences that rotor ablation suppresses atrial fibrillation (AF) inducibility.Background Micro-re-entrant wavefronts have been suggested to serve as sources of rapid activations during AF. Whether AF inducibility is suppressed by elimination of rotors remains unknown.Methods We used optical mapping to study Langendorff-perfused left pulmonary vein (PV)-left atrium (LA) preparations from 13 dogs with pacing-induced heart failure. Atrial arrhythmias were induced by pacing and mapped during acetylcholine infusion (1 mu mol/l). Rotors were identified from optical recordings. Epicardial ablation was performed targeting the rotor anchoring sites in preparations with sustained (>10 min) or incessant spontaneous AF. Non-rotor ablation was performed in 4 preparations. Repeated pacing was performed to test the AF inducibility after ablation.Results Sustained AF (n = 12) and incessant spontaneous AF (n = 1) were induced after acetylcholine infusion. Pulmonary vein focal discharge was found in 9 preparations (9.2 +/- 4.2 beats/s), and rotor anchoring was found at the left superior PV-LA junction in 13 preparations (9.1 +/- 4.6 beats/s) and at the ligament of Marshall-PV-LA junction in 1 preparation. Epicardial rotor ablation successfully inhibited the inducibility of sustained AF in 12 of 13 preparations (p < 0.01), including 4 with the maximal dominant frequency sites located on the PV-LA junctional rotor zones (direct elimination of mother rotors). The longest AF duration was shortened significantly by rotor ablation (Wilcoxon Z = 3.60, p = 0.002, n = 13), but not by non-rotor ablation (Wilcoxon Z = 1.00, p = 0.317, n = 4).Conclusions Epicardial ablation of the rotor anchoring sites suppresses AF inducibility. The arrhythmogenicity at the maximal dominant frequency sites is directly/indirectly suppressed by the rotor ablation. (J Am Coll Cardiol 2011;58:158-66) (C) 2011 by the American College of Cardiology Foundation