Clinical Mapping Approach To Diagnose Electrical Rotors and Focal Impulse Sources for Human Atrial Fibrillation
Clinical Mapping Approach To Diagnose Electrical Rotors and Focal Impulse Sources for Human Atrial Fibrillation
复制标题
DOI：
10.1111/j.1540-8167.2012.02332.x
复制
发表时间：
2012-05-01
影响因子：
2.7
通讯作者：
Rappel, Wouter-Jan
中科院分区：
文献类型：
--
作者：
Narayan, Sanjiv M.;Krummen, David E.;Rappel, Wouter-Jan
人类房颤中转子和局灶性脉冲的计算映射。引言：人类房颤（AF）的永久机制尚未确定。局部转子和局灶性搏动源可能在优雅的动物模型中维持AF，但使用传统方法在人类AF中没有直接证据。我们开发了一种临床计算标测方法，以人类心房组织生理学为指导，以揭示人类AF的来源。（62 +/- 9岁; 30例持续性），我们使用单相动作电位（MAP）定义复极动力学，并记录左心房64极篮状导管的AF激活，在n = 20例患者中，两个心房需要仔细定位网篮导管以实现最佳标测。将64128个电极的AF电描记图与复极和传导动力学相结合，以构建时空AF图。我们在49例患者中观察到47例持续源，以电转子（n = 57）和局灶性搏动（n = 11）的形式控制局部心房激动伴外周波中断（间歇性传导）。持续性房颤患者的房颤源比阵发性房颤患者多（2.1 +/- 1.0 vs 1.5 +/- 0.8，P = 0.02），与较短的周期长度相关（163 +/- 19毫秒vs 187 +/- 25毫秒，P < 0.001）。大约四分之一的来源位于右心房。结论：生理学引导的计算映射首次揭示了人类AF期间持续的电转子和重复的局灶性搏动。这些局部源存在于96%的AF患者中，并控制AF活动。这些结果为人类AF提供了新的机制见解，并为AF消融的机制定制方法奠定了基础。（J.E. Vasc Electrophysiol，第23卷，第100页）447-454，2012年5月）
Computational Mapping of Rotors and Focal Impulses in Human AF. Introduction: The perpetuating mechanisms for human atrial fibrillation (AF) remain undefined. Localized rotors and focal beat sources may sustain AF in elegant animal models, but there has been no direct evidence for localized sources in human AF using traditional methods. We developed a clinical computational mapping approach, guided by human atrial tissue physiology, to reveal sources of human AF. Methods and Results: In 49 AF patients referred for ablation (62 +/- 9 years; 30 persistent), we defined repolarization dynamics using monophasic action potentials (MAPs) and recorded AF activation from 64-pole basket catheters in left atrium and, in n = 20 patients, in both atria. Careful positioning of basket catheters was required for optimal mapping. AF electrograms at 64128 electrodes were combined with repolarization and conduction dynamics to construct spatiotemporal AF maps. We observed sustained sources in 47/49 patients, in the form of electrical rotors (n = 57) and focal beats (n = 11) that controlled local atrial activation with peripheral wavebreak (fibrillatory conduction). Patients with persistent AF had more sources than those with paroxysmal AF (2.1 +/- 1.0 vs 1.5 +/- 0.8, P = 0.02), related to shorter cycle length (163 +/- 19 milliseconds vs 187 +/- 25 milliseconds, P < 0.001). Approximately one-quarter of sources lay in the right atrium. Conclusions: Physiologically guided computational mapping revealed sustained electrical rotors and repetitive focal beats during human AF for the first time. These localized sources were present in 96% of AF patients, and controlled AF activity. These results provide novel mechanistic insights into human AF and lay the foundation for mechanistically tailored approaches to AF ablation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 447-454, May 2012)