Determinants of new wavefront locations in cholinergic atrial fibrillation
Determinants of new wavefront locations in cholinergic atrial fibrillation
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DOI：
10.1093/europace/euy235
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发表时间：
2018-11-01
期刊：
影响因子：
6.1
通讯作者：
Vigmond，Edward J.
中科院分区：
文献类型：
--
作者：
Roney，Caroline H.;Ng，Fu Siong;Vigmond，Edward J.
目的 房颤 (AF) 波前动力学非常复杂且难以解释，导致房颤维持机制的不确定性。我们的目的是研究颤动过程中转子、小波和焦点源之间的相互作用。方法和结果对四种光学映射犬胆碱能 AF 制剂的心律失常波前动力学进行了分析。双层计算机模型根据实验准备进行调整，并变化为（i）两层或仅心外膜纤维化，（ii）不同的空间乙酰胆碱分布，（iii）各层之间不同的内在动作电位持续时间，以及（iv）不同的层间连接性。随着时间的推移，相位奇点 (PS) 被识别和跟踪，以识别旋转驱动因素。使用相位轮廓识别新的焦点波前。 AF 期间计算相位奇点密度和新波前位置。在每种准备工作中，都有一个维持 AF 的主要机制，要么是旋转驱动器，要么是重复的新焦点波前。高密度PS位点优先存在于肺静脉交界处周围。四种制剂中的三种表现出稳定的新波前优先位点。计算模拟预测，只有少数连接在维持 AF 方面具有重要功能，新波前位置由纤维化分布、乙酰胆碱浓度和层内复极异质性之间的相互作用决定。结论我们能够识别新波前启动和旋转活动的优先位点，以确定维持 AF 的机制。根据电测量是心内膜还是心外膜记录，应以不同的方式解释电测量。
AimsAtrial fibrillation (AF) wavefront dynamics are complex and difficult to interpret, contributing to uncertainty about the mechanisms that maintain AF. We aimed to investigate the interplay between rotors, wavelets, and focal sources during fibrillation.Methods and resultsArrhythmia wavefront dynamics were analysed for four optically mapped canine cholinergic AF preparations. A bilayer computer model was tuned to experimental preparations, and varied to have (i) fibrosis in both layers or the epicardium only, (ii) different spatial acetylcholine distributions, (iii) different intrinsic action potential duration between layers, and (iv) varied interlayer connectivity. Phase singularities (PSs) were identified and tracked over time to identify rotational drivers. New focal wavefronts were identified using phase contours. Phase singularity density and new wavefront locations were calculated during AF. There was a single dominant mechanism for sustaining AF in each of the preparations, either a rotational driver or repetitive new focal wavefronts. High-density PS sites existed preferentially around the pulmonary vein junctions. Three of the four preparations exhibited stable preferential sites of new wavefronts. Computational simulations predict that only a small number of connections are functionally important in sustaining AF, with new wavefront locations determined by the interplay between fibrosis distribution, acetylcholine concentration, and heterogeneity in repolarization within layers.ConclusionWe were able to identify preferential sites of new wavefront initiation and rotational activity, in order to determine the mechanisms sustaining AF. Electrical measurements should be interpreted differently according to whether they are endocardial or epicardial recordings.