Organizational Index Mapping to Identify Focal Sources During Persistent Atrial Fibrillation
Organizational Index Mapping to Identify Focal Sources During Persistent Atrial Fibrillation
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DOI：
10.1111/jce.12352
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发表时间：
2014-04-01
影响因子：
2.7
通讯作者：
Peters, Nicholas S.
中科院分区：
文献类型：
--
作者：
Jarman, Julian W. E.;Wong, Tom;Peters, Nicholas S.
心房颤动的组织指数图介绍局部转子与持续性心房颤动（AF）的机制有关。虽然左心房（LA）频谱分析的最高主频（DF）区域被认为可以识别转子，但其他机制（如波前碰撞）也会偶尔产生不一致的高DF分布。我们假设，如果驱动程序的AF存在，其独特的频谱特性将导致更多的时间稳定性比他们的highfrequency.Methods和ResultsTen持续性AF患者进行LA非接触式映射。减去远场心室成分后，对256个部位的非接触电描记图进行快速傅立叶变换。将5个连续7秒AF段之间DF的平均绝对差异定义为每个部位的DF变异性（DFV）。定义DF及其谐波与频谱总功率的平均比值为组织指数（OI）。组织化区域的平均DFV显著低于所有部位（0.34 +/- 0.04 vs 0.46 +/- 0.04 Hz; P < 0.001）。当在大面积环周消融过程中消融有组织的区域时，AF在远端区域有组织（消融与未消融的LA附件Delta OI：+0.21 [0.06-0.41] vs -0.04 [-0.14-0.05]; P = 0.005）。这一观察结果与局灶源的存在是一致的，而与纯粹随机的激活模式不一致。消融这些区域在技术上是可行的，并且与远端心房区域的AF组织化相关。
Organizational Index Maps of AFIntroductionLocalized rotors have been implicated in the mechanism of persistent atrial fibrillation (AF). Although regions of highest dominant frequency (DF) on spectral analysis of the left atrium (LA) have been said to identify rotors, other mechanisms such as wavefront collisions will sporadically also generate an inconsistent distribution of high DF. We hypothesized that if drivers of AF were present, their distinctive spectral characteristics would result more from their temporal stability than their high frequency.Methods and ResultsTen patients with persistent AF underwent LA noncontact mapping. Following subtraction of far-field ventricular components, noncontact electrograms at 256 sites underwent fast Fourier transform. Mean absolute difference in DF between 5 sequential 7-second segments of AF was defined as the DF variability (DFV) at each site. Mean ratio of the DF and its harmonics to the total power of the spectrum was defined as the organizational index (OI). Mean DFV was significantly lower in organized areas (OI > 1 SD above mean) than at all sites (0.34 +/- 0.04 vs 0.46 +/- 0.04 Hz; P < 0.001). When organized areas were ablated during wide-area circumferential ablation, AF organized in remote regions (LA appendage Delta OI ablated vs unablated: +0.21 [0.06-0.41] vs -0.04 [-0.14-0.05]; P = 0.005).ConclusionsAt sites of organized activation, the activation frequency was also significantly more stable over time. This observation is consistent with the existence of focal sources, and inconsistent with a purely random activation pattern. Ablation of such regions is technically feasible, and was associated with organization of AF in remote atrial regions.