Reconsidering the multiple wavelet hypothesis of atrial fibrillation.

Reconsidering the multiple wavelet hypothesis of atrial fibrillation.
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DOI:
10.1016/j.hrthm.2020.06.017
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发表时间:
2020-11
期刊:
影响因子:
5.5
通讯作者:
Waldo AL
Waldo AL
中科院分区:
医学2区
文献类型:
--
作者:
Lee S;Khrestian CM;Sahadevan J;Waldo AL

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Moe/Abildskov proposed the multiple wavelet hypothesis of atrial fibrillation (AF) based on observations in the canine vagal nerve stimulation (VNS) AF model. Data from mapping studies in in vitro canine AF model by Allessie et al. evaluated the Moe/Abildskov hypothesis, concluding that a critical number of wavelets sustained AF. To reassess VNS mapping data using the same methods used by Allessie to evaluate Moe’s multiple wavelet hypothesis. Using the canine VNS AF model in 6 dogs, 510 unipolar AEGs were recorded simultaneously from both atria. Activation sequence maps were produced from sustained AF during VNS in each dog. Per Allessie, consecutive 10ms activation windows were analyzed during 300ms. Repetitive activation analysis was applied to Moe’s canine VNS AF model. The number of wavefronts in each AF episode was 0–8 in Allessie’s studies measured by sequential atrial mapping; 0–10 in our bi-atrial simultaneous mapping studies. In both studies, an electrically silent period was observed in each atrium, and was reactivated by wavefronts emanating from focal sources. Allessie postulated that an electrically silent atrium was reactivated by a wavefront propagating from the other atrium. However, in our bi-atrial simultaneous mapping studies, each electrically silent atrium was reactivated by a distinct focal source. Data from both studies showed a similar number of wavefronts, similar AF activation patterns, and periods of an electrical atrial silence reactivated by focal sources. Also, in our studies, independent focal sources initiated wavefronts reactivating the atria, thereby explaining the mechanism maintaining AF.
稳定转子或焦点源的直接或巧合消除可能解释了成功的房颤消融:确认试验的对治疗分析(对AF的常规消融有或没有局灶性脉冲脉冲和转子调制)。
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