Localized sources maintaining atrial fibrillation organized by prior ablation
Localized sources maintaining atrial fibrillation organized by prior ablation
复制标题
DOI：
10.1161/circulationaha.105.546648
复制
发表时间：
2006-02-07
期刊：
影响因子：
37.8
通讯作者：
Jaïs, P
中科院分区：
文献类型：
--
作者：
Haïssaguerre, M;Hocini, M;Jaïs, P
背景-人类心房颤动（AF）局部源的心内膜定位尚未报道。方法与结果：对50例房颤患者进行了既往肺静脉消融和线性消融的研究。如果房颤期间的定位显示不规则但离散的心房复体，在> 75%的时间内表现出一致的激活序列，则认为房颤是有组织的，使用20极导管，5根辐射刺覆盖3.5 cm直径或顺序常规定位。以离心方式激活剩余心房组织的部位或区域被定义为心房源。在周期长度为211 +/- 32 ms的房颤期间，激活图谱在38例（76%）患者的心房波阵面起始处确定了1至3个源，主要位于左心房，包括冠状窦区。最早区域的电图变化从离散的离心激活到42%的病例中跨越75%到100%周期长度的活动，后者表明复杂的局部传导或重入电路。28%的患者观察到周期长度（bbb20 ms）向周围心房的梯度。局部射频消融使AF周期延长28±22 ms，终止AF或将激活顺序改变为另一种有组织的节律。在4例患者中，驱动源被隔离，以窦性心律被心房包围，并仍以高频（228 +/- 31 ms）永久或间歇放电。结论-房颤与先前消融后一致的心房激活序列相关，主要来自可定位和消融的局部源。一些消息来源的电图显示局部再入的存在。
Background - Endocardial mapping of localized sources driving atrial fibrillation (AF) in humans has not been reported.Methods and Results - Fifty patients with AF organized by prior pulmonary vein and linear ablation were studied. AF was considered organized if mapping during AF showed irregular but discrete atrial complexes exhibiting consistent activation sequences for > 75% of the time using a 20-pole catheter with 5 radiating spines covering 3.5-cm diameter or sequential conventional mapping. A site or region centrifugally activating the remaining atrial tissue defined a source. During AF with a cycle length of 211 +/- 32 ms, activation mapping identified 1 to 3 sources at the origin of atrial wavefronts in 38 patients (76%) predominantly in the left atrium, including the coronary sinus region. Electrograms at the earliest area varied from discrete centrifugal activation to an activity spanning 75% to 100% of the cycle length in 42% of cases, the latter indicating complex local conduction or a reentrant circuit. A gradient of cycle length (> 20 ms) to the surrounding atrium was observed in 28%. Local radiofrequency ablation prolonged AF cycle length by 28 +/- 22 ms and either terminated AF or changed activation sequence to another organized rhythm. In 4 patients, the driving source was isolated, surrounded by the atrium in sinus rhythm, and still firing at high frequency (228 +/- 31 ms) either permanently or in bursts.Conclusions - AF associated with consistent atrial activation sequences after prior ablation emanates mostly from localized sources that can be mapped and ablated. Some sources harbor electrograms suggesting the presence of localized reentry.