Spatial and temporal relationship between focal and rotational drivers and their relationship to structural remodeling in patients with persistent AF
Spatial and temporal relationship between focal and rotational drivers and their relationship to structural remodeling in patients with persistent AF
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局灶性驱动因素和旋转驱动因素之间的时空关系及其与持续性房颤患者结构重塑的关系
DOI：
10.1101/2023.09.01.23294966
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Honarbakhsh S
中科院分区：
文献类型：
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作者：
Honarbakhsh S
背景在心房颤动（AF）中已经证实了局灶性和旋转性激动，但是它们之间的关系以及它们与结构重塑的关系还不清楚。这项研究的目的是评估局灶性和旋转性激活与潜在的低电压区（LVZ）的关系。（<0.5 mV），并确定是否有一个时间（≤500 ms）和空间（≤12 mm）之间的关系，这些activationsMethodsPatients接受导管消融术的持续性AF。所有患者均行肺静脉电隔离术。单极信号收集，以确定使用波前传播algorithm.ResultsIn 40例患者，105激活（57 [54.3%]局灶性; 48 [45.7%]旋转）的局灶性和旋转激活。旋转激活共定位于LVZ（35/48 [72.9%]），而局灶性激活不定位于LVZ（11/57 [19.3%];P<0.001）。左心房被左心室Z占据的比例预测旋转激动的发生（曲线下面积0.96; 95%置信区间0.90-1.00;P<0.001）。在心房相对健康的患者中，其中心房由≤15% LVZ组成，仅识别出局灶性激动。35个旋转激活中的32个（91.4%）位于LVZ也显示出与局灶性激活的时间和空间关系。LVZ内12毫米的局灶性激活的存在是一个强有力的预测是否成对的旋转激活也会发生在该neighborhood.ConclusionRotational激活主要局限于结构重塑领域，并有一个明确的空间和时间的局灶性激活的关系，这表明他们是依赖于他们。这些新的机制观察概述了维持AF的患者特异性机制的合理模型。
BackgroundFocal and rotational activations have been demonstrated in atrial fibrillation (AF), but their relationship to each other and to structural remodeling remains unclear.ObjectiveThe purpose of this study was to assess the relationship of focal and rotational activations to underlying low-voltage zones (LVZs) (<0.5 mV) and to determine whether there was a temporal (≤500 ms) and spatial (≤12 mm) relationship between these activations.MethodsPatients undergoing catheter ablation for persistent AF were included. All patients underwent pulmonary vein isolation. Unipolar signals were collected to identify focal and rotational activations using a wavefront propagation algorithm.ResultsIn 40 patients, 105 activations were identified (57 [54.3%] focal; 48 [45.7%] rotational). Rotational activations were co-localized to LVZs (35/48 [72.9%]) whereas focal activations were not (11/57 in LVZ [19.3%];P<.001). The proportion of the left atrium occupied by LVZs predicted rotational activations occurrence (area under the curve 0.96; 95% confidence interval 0.90–1.00;P<.001). In patients with a relatively healthy atrium, in which the atrium consisted of ≤15% LVZs, only focal activations were identified. Thirty-two of the 35 rotational activations (91.4%) located in LVZs also showed a temporal and spatial relationship to a focal activation. The presence of a LVZ within 12 mm of the focal activation was a strong predictor for whether a paired rotational activation would also occur in that vicinity.ConclusionRotational activations are largely confined to areas of structural remodeling and have a clear spatial and temporal relationship with focal activations suggesting they are dependent on them. These novel mechanistic observations outline a plausible model for patient-specific mechanisms maintaining AF.