A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate
A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate
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DOI：
10.1016/j.jacc.2003.12.054
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发表时间：
2004-06-02
影响因子：
24
通讯作者：
Ngarmukos, T
中科院分区：
文献类型：
--
作者：
Nademanee, K;McKenzie, J;Ngarmukos, T
我们试图检验这一假设，即心房颤动（AF）期间记录的复杂碎裂电图（CFAE）可用作AF导管消融的靶点。我们假设，这些领域的CFAE可以确定在AF患者，并可能作为导管消融的靶点，以维持窦性心律。方法研究人群包括121例（29名女性，平均年龄63岁）与难治性AF（57阵发性，64慢性）。所有患者在AF期间接受非透视电解剖标测（CARTO）。使用CARTO，在AF期间创建双心房复制品（显示在三维彩色编码电压标测图中），并识别与CFAE相关的区域。结果复杂碎裂心房电图出现在两房9个部位中的7个部位，但主要局限于房间隔、肺静脉、左房顶、左后间隔二尖瓣环和冠状窦口。消融与CFAE相关的区域导致115/121例患者（95%）AF终止，无需体外心脏复律; 32例（28%）患者需要同时接受伊布利特治疗。在一年的随访中，110例（91%）患者的心律失常和症状，92后一次消融和18后two.CONCLUSIONS地区与CFAE代表一个明确的电生理基板和消融消除AF和维持正常窦性心律的理想目标网站。(C)2004年，美国心脏病学会基金会。
OBJECTIVES We sought to test the hypothesis that complex fractionated electrograms (CFAEs) recorded during atrial fibrillation (AF) could be used as target sites for catheter ablation of AF.BACKGROUND Mapping of AF in humans has shown that areas of CFAEs correlate with areas of slowed conduction and pivot points of reentrant wavelets. We hypothesized that such areas of CFAEs could be identified in patients with AF and might serve as target sites for catheter ablation to maintain sinus rhythm.METHODS The study population included 121 patients (29 females; mean age, 63 years) with refractory AF (57 paroxysmal, 64 chronic). All patients underwent nonfluoroscopic electroanatomic mapping (CARTO) during AF. Using CARTO, the biatrial replica, displayed in a three-dimensional color-coded voltage map, was created during AF, and areas associated with CFAEs were identified. Radiofrequency ablation of the area with CFAEs was performed, aiming to eliminate CFAE and/or convert to sinus rhythm.RESULTS Complex fractionated atrial electrograms were found in seven of nine regions of both atria, but were mainly confined to the interatrial septum, pulmonary veins, roof of left atrium, and left posteroseptal mitral annulus and coronary sinus ostium. Ablations of the areas associated with CFAEs resulted in termination of AF without external cardioversion in 115 of the 121 patients (95%); 32 (28%) required concomitant ibutilide treatment. At the one-year follow-up, 110 (91%) patients were free of arrhythmia and symptoms, 92 after one ablation and 18 after two.CONCLUSIONS Areas with CFAEs represent a defined electrophysiologic substrate and are ideal target sites for ablations to eliminate AF and maintain normal sinus rhythm. (C) 2004 by the American College of Cardiology Foundation.