Characterization of Foci and Breakthrough Sites During Persistent and Long-Standing Persistent Atrial Fibrillation in Patients: Studies Using High-Density (510-512 Electrodes) Biatrial Epicardial Mapping.
Characterization of Foci and Breakthrough Sites During Persistent and Long-Standing Persistent Atrial Fibrillation in Patients: Studies Using High-Density (510-512 Electrodes) Biatrial Epicardial Mapping.
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DOI：
10.1161/jaha.116.005274
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发表时间：
2017-03-17
影响因子：
5.4
通讯作者：
Waldo AL
中科院分区：
文献类型：
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作者：
Lee S;Sahadevan J;Khrestian CM;Markowitz A;Waldo AL
我们之前证明了持续性和长期持续性房颤是由不同周期长度（CL）的病灶和突破部位发出的激活维持的。本研究的目的是描述这些患者在房颤高密度标测期间识别的局灶性和非随机突破性激动的行为。在心内直视手术期间，我们在12例持续性和长期持续性房颤患者中使用510至512个心外膜电极沿着ECG导联II同时记录了两个心房的激动。对于每例患者，分析从确定的局灶性（持续和/或间歇性）和非随机突破部位连续32秒的激活。12例患者中有11例患者的两个心房均存在不同CL的多个病灶（持续性和/或间歇性）; 8个病灶持续存在，22个病灶间歇存在。持续病灶的时间CL行为随时间变化（平均CL ≤20 ms）。对于间歇性病灶，没有激活期是由于自发暂停（18/22）或另一波阵面激活病灶（11/22）。所有患者均有突破性激活。7例患者有12个非随机突破部位。无突破性激活的周期是由自发暂停（12例患者中的6例）或来自另一个波前的激活（12例患者中的4例）或不确定（12例患者中的5例）引起的。局灶性和非随机突破激活有时会产生重复的“wannabe”（不完全）折返12例患者中的6例。在持续性和长期持续性房颤期间，持续性病灶表现出可变CL。自发暂停或激活从其他波阵面解释了病灶的不连续性和非随机突破。局灶性和非随机突破激活偶尔会产生想要再入。
We previously demonstrated that persistent and long‐standing persistent atrial fibrillation is maintained by activation emanating from foci and breakthrough sites of different cycle lengths (CLs). The purpose of this study was to characterize the behavior of focal and nonrandom breakthrough activation identified during high‐density mapping of atrial fibrillation in these patients. During open heart surgery, we recorded activation from both atria simultaneously using 510 to 512 epicardial electrodes along with ECG lead II in 12 patients with persistent and long‐standing persistent atrial fibrillation. For each patient, analysis of 32 consecutive seconds of activation from identified focal (sustained and/or intermittent) and nonrandom breakthrough sites was performed. Multiple foci (sustained and/or intermittent) of different CLs were present in both atria in 11 of 12 patients; 8 foci were sustained, and 22 were intermittent. Temporal CL behavior of sustained foci varied over time (≤20 ms of the mean CL). For intermittent foci, no activation periods were due to a spontaneous pause (18 of 22) or activation of the focus by another wave front (11 of 22). All patients had breakthrough activation. Seven patients had 12 nonrandom breakthrough sites. Periods of no breakthrough activation were caused by a spontaneous pause (6 of 12 patients) or activation from another wave front (4 of 12) or were uncertain (5 of 12). Focal and nonrandom breakthrough activation sometimes produced repetitive “wannabe” (incomplete) reentry in 6 of 12 patients. During persistent and long‐standing persistent atrial fibrillation, sustained foci manifested variable CLs. Spontaneous pauses or activation from other wave fronts explained the intermittency of foci and nonrandom breakthrough. Focal and nonrandom breakthrough activation occasionally produced wannabe reentry.