Simultaneous Whole-Chamber Non-contact Mapping of Highest Dominant Frequency Sites During Persistent Atrial Fibrillation: A Prospective Ablation Study.
Simultaneous Whole-Chamber Non-contact Mapping of Highest Dominant Frequency Sites During Persistent Atrial Fibrillation: A Prospective Ablation Study.
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DOI：
10.3389/fphys.2022.826449
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发表时间：
2022
影响因子：
4
通讯作者：
Ng GA
中科院分区：
文献类型：
--
作者：
Chu GS;Li X;Stafford PJ;Vanheusden FJ;Salinet JL;Almeida TP;Dastagir N;Sandilands AJ;Kirchhof P;Schlindwein FS;Ng GA
持续性房颤（persAF）的许多潜在机制涉及最高主频（HDF）部位。我们假设，前瞻性识别和消融动态左心房HDF部位将有利地影响persAF的电生理底物。我们的目的是评估通过全局同步左心房标测前瞻性识别HDF部位的可行性。既往无消融史的房颤患者接受了全局同步左心房非接触标测。将AF期间记录的30 s电描记图导出到定制的MATLAB界面中，以识别HDF区域，然后在肺静脉隔离之前将其作为消融目标。每个区域消融后，记录房颤周期长度（AFCL）的变化（≥ 10 ms视为显著）。回顾性分析消融区域的基线等电位图，寻找转子和局灶性激活或消退事件。在10名患者中共识别并消融了51个HDF区域（中位DF 5.8 Hz，范围4.4- 7.1 Hz）。在51个地区中的20个（39%）观察到AFCL增加，包括4例患者的AF终止。10例患者中有5例（包括4例房颤终止的患者，采用HDF引导消融术）在1年时无房颤复发。消融区域的HDF发生比例与AFCL变化无关（τ = 0.11，p = 0.24）。AFCL降低10 ms或以上的区域（即，消融术后的AF紊乱）也显示出最低的基线频谱组织（任何比较p < 0.033）。考虑到所有消融区域，HDF事件也是HRI事件的平均比例为8.0 ± 13%。在等电位图上消融区域中，局灶性激活占主导地位（537/1253起事件），与消融区域代表的HDF发生比例适度相关（Kendall τ = 0.40，p < 0.0001），与局灶性消退事件非常密切相关（τ = 0.79，p < 0.0001）。转子罕见（4/1253起事件）。靶向动态HDF位点是可行的并且可以是有效的，但是在鉴定相关的人persAF底物方面缺乏特异性。光谱组织可以在防止不必要的衬底烧蚀方面具有预防作用。动态HDF位点与等电位标测上可观察到的旋转活动无关，但epi-endoconstructions突破可能有贡献。
Sites of highest dominant frequency (HDF) are implicated by many proposed mechanisms underlying persistent atrial fibrillation (persAF). We hypothesized that prospectively identifying and ablating dynamic left atrial HDF sites would favorably impact the electrophysiological substrate of persAF. We aim to assess the feasibility of prospectively identifying HDF sites by global simultaneous left atrial mapping. PersAF patients with no prior ablation history underwent global simultaneous left atrial non-contact mapping. 30 s of electrograms recorded during AF were exported into a bespoke MATLAB interface to identify HDF regions, which were then targeted for ablation, prior to pulmonary vein isolation. Following ablation of each region, change in AF cycle length (AFCL) was documented (≥ 10 ms considered significant). Baseline isopotential maps of ablated regions were retrospectively analyzed looking for rotors and focal activation or extinction events. A total of 51 HDF regions were identified and ablated in 10 patients (median DF 5.8Hz, range 4.4–7.1Hz). An increase in AFCL of was seen in 20 of the 51 regions (39%), including AF termination in 4 patients. 5 out of 10 patients (including the 4 patients where AF termination occurred with HDF-guided ablation) were free from AF recurrence at 1 year. The proportion of HDF occurrences in an ablated region was not associated with change in AFCL (τ = 0.11, p = 0.24). Regions where AFCL decreased by 10 ms or more (i.e., AF disorganization) after ablation also showed lowest baseline spectral organization (p < 0.033 for any comparison). Considering all ablated regions, the average proportion of HDF events which were also HRI events was 8.0 ± 13%. Focal activations predominated (537/1253 events) in the ablated regions on isopotential maps, were modestly associated with the proportion of HDF occurrences represented by the ablated region (Kendall’s τ = 0.40, p < 0.0001), and very strongly associated with focal extinction events (τ = 0.79, p < 0.0001). Rotors were rare (4/1253 events). Targeting dynamic HDF sites is feasible and can be efficacious, but lacks specificity in identifying relevant human persAF substrate. Spectral organization may have an adjunctive role in preventing unnecessary substrate ablation. Dynamic HDF sites are not associated with observable rotational activity on isopotential mapping, but epi-endocardial breakthroughs could be contributory.
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DOI：
10.1161/circep.111.969519
发表时间：
2012-12
期刊：
Circulation. Arrhythmia and electrophysiology
影响因子：
--
作者：
Filgueiras-Rama D;Price NF;Martins RP;Yamazaki M;Avula UM;Kaur K;Kalifa J;Ennis SR;Hwang E;Devabhaktuni V;Jalife J;Berenfeld O
通讯作者：
Berenfeld O
影响因子：
24
作者：
Earley, Mark J.;Abrams, Dominic J. R.;Schilling, Richard J.
通讯作者：
Schilling, Richard J.
影响因子：
2.7
作者：
Jarman, Julian W. E.;Wong, Tom;Peters, Nicholas S.
通讯作者：
Peters, Nicholas S.
影响因子：
2.7
作者：
Honarbakhsh, Shohreh;Schilling, Richard J.;Hunter, Ross J.
通讯作者：
Hunter, Ross J.
影响因子：
8.4
作者：
de Groot, Natasja;van der Does, Lisette;Allessie, Maurits
通讯作者：
Allessie, Maurits