Atrial Fibrillation After Cardiac Surgery: Electrophysiological Mechanism and Outcome
Atrial Fibrillation After Cardiac Surgery: Electrophysiological Mechanism and Outcome
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DOI：
10.1016/j.athoracsur.2019.12.069
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发表时间：
2020-06-01
影响因子：
4.6
通讯作者：
Ad, Niv
中科院分区：
文献类型：
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作者：
Ehrlich, Marek P.;Osorio-Jaramillo, Emilio;Ad, Niv
背景资料。术后心房颤动(POAF)是心脏手术后常见的并发症，且预后较差。与非POAF相比，POAF的高治愈率引发了关于电生理机制的问题。尽管POAF很常见，但到目前为止还没有对POAF的电生理机制进行评估。10名POAF患者(5名男性，平均年龄75±5岁)接受了无创三维逐搏标测，并与10名接受心脏直视手术的持续性房颤(PEAF)患者(6名男性，平均年龄70+/-10岁)进行了比较。使用经过验证的波尔多分类，根据焦点和转子活动的性质和位置对三维标测进行比较。所有患者的两个心房都有转子活动；POAF组有299个转子(平均30+/-12个)，PEAF组有289个(平均29+/-22个)。两组大折返最常见的部位是肺静脉区。左房和左心耳活动分别占全部驾驶员的59%(177/299)和62%(180/289)。所有患者都记录了右心房的转子活动。POAF组只有2例患者有局灶性活动，PEAF组有6例患者有局部活动。POAF的作用机理与PEAF相当。两组的转子活动相似，但局灶性活动在POAF组中较少见，这可能与心房组织重塑的差异有关。在POAF中，短暂的底物变化似乎促进了AF的发展。通过标测和组织分析更好地了解心房组织的变化，应该会导致更好的预防方法。(C)2020年，由胸外科医生学会主办
Background. Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with an inferior outcome. The high cure rate compared with non-POAF raises questions regarding the electrophysiologic mechanism. Despite being common, until now the electrophysiologic mechanism of POAF was never assessed.Methods. Ten patients (5 men; mean age, 75 +/- 5 years) with POAF underwent noninvasive 3-dimensional beat-by-beat mapping and were compared with 10 patients (6 men; mean age, 70 +/- 10 years) with preoperative persistent AF (PEAF) undergoing open heart procedures. Three-dimensional mappings were compared by the nature and location of focal and rotor activity using the validated Bordeaux classification.Results. Rotor activity was present in both atria of all patients; 299 rotors (mean, 30 +/- 12) were mapped in the POAF group and 289 (mean, 29 +/- 22) in the PEAF group. The most common region for macro reentry in both groups was the pulmonary vein area. Left atrium and left atrial appendage activity accounted for 59% (177/299 POAF group) and 62% (180/289 PEAF group) of all drivers. Rotor activity in the right atrium was documented in all patients. Focal activity was captured in only 2 patients in the POAF group and in 6 patients in the PEAF group.Conclusions. The mechanism of POAF is comparable with that of PEAF. Rotor activity was similar in both groups, but focal activity was numerically less common in the POAF group, which may be related to differences in atrial tissue remodeling. In POAF, transient substrate changes seem to facilitate the development of AF. A better understanding of atrial tissue changes by mapping and tissue analysis should lead to better preventive approaches. (C) 2020 by The Society of Thoracic Surgeons