Quantitative analysis of localized sources identified by focal impulse and rotor modulation mapping in atrial fibrillation.
Quantitative analysis of localized sources identified by focal impulse and rotor modulation mapping in atrial fibrillation.
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DOI：
10.1161/circep.115.002721
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
Mandapati R
中科院分区：
文献类型：
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作者：
Benharash P;Buch E;Frank P;Share M;Tung R;Shivkumar K;Mandapati R
房颤（AF）消融的新方法包括局灶脉冲和转子调制（FIRM）标测，该技术的初步结果报告是有利的。我们试图通过分析心房电描记图的定量特征来独立评价该方法，该心房电描记图用于识别转子并描述FIRM引导消融的急性手术结局。纳入加州大学洛杉矶医学中心的所有FIRM引导消融术（n=24; 50%阵发性）进行分析。在AF期间，从64极篮状导管收集的单极心房电描记图用于构建相位图并识别推定的AF源。这些部位是消融的靶点，大多数患者（n=19; 79%）结合肺静脉隔离。所有患者均识别出转子（平均2.3±0.9/患者; 72%在左心房）。24例患者中有12例（50%）达到了预定的急性手术终点：房颤终止（n=1）、机化（n=3）或房颤周期长度减慢>10%（n=8）。篮状电极位于54%左心房表面积的1厘米范围内，每名患者平均有31个电极显示可解释的心房电描记图。离线分析显示，转子和遥远的网站之间没有显着差异的主频或香农熵。电解剖标测显示，24例患者中有23例（96%）在FIRM识别的转子部位没有旋转激活。FIRM识别的转子部位未表现出转子预期的定量心房电描记图特征，并且与周围组织无定量差异。在这些部位进行导管消融，结合肺静脉隔离，导致少数患者房颤终止或机化（4/24; 17%）。有必要进一步验证这一方法。
New approaches to ablation of atrial fibrillation (AF) include focal impulse and rotor modulation (FIRM) mapping, and initial results reported with this technique have been favorable. We sought to independently evaluate the approach by analyzing quantitative characteristics of atrial electrograms used to identify rotors and describe acute procedural outcomes of FIRM-guided ablation. All FIRM-guided ablation procedures (n=24; 50% paroxysmal) at University of California, Los Angeles Medical Center were included for analysis. During AF, unipolar atrial electrograms collected from a 64-pole basket catheter were used to construct phase maps and identify putative AF sources. These sites were targeted for ablation, in conjunction with pulmonary vein isolation in most patients (n=19; 79%). All patients had rotors identified (mean, 2.3±0.9 per patient; 72% in left atrium). Prespecified acute procedural end point was achieved in 12 of 24 (50%) patients: AF termination (n=1), organization (n=3), or >10% slowing of AF cycle length (n=8). Basket electrodes were within 1 cm of 54% of left atrial surface area, and a mean of 31 electrodes per patient showed interpretable atrial electrograms. Offline analysis revealed no differences between rotor and distant sites in dominant frequency or Shannon entropy. Electroanatomic mapping showed no rotational activation at FIRM-identified rotor sites in 23 of 24 patients (96%). FIRM-identified rotor sites did not exhibit quantitative atrial electrogram characteristics expected from rotors and did not differ quantitatively from surrounding tissue. Catheter ablation at these sites, in conjunction with pulmonary vein isolation, resulted in AF termination or organization in a minority of patients (4/24; 17%). Further validation of this approach is necessary.