Panoramic Endocardial Optical Mapping Demonstrates Serial Rotors Acceleration and Increasing Complexity of Activity During Onset of Cholinergic Atrial Fibrillation.
Panoramic Endocardial Optical Mapping Demonstrates Serial Rotors Acceleration and Increasing Complexity of Activity During Onset of Cholinergic Atrial Fibrillation.
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DOI：
10.1161/jaha.121.022300
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发表时间：
2021-11-16
影响因子：
5.4
通讯作者：
Berenfeld O
中科院分区：
文献类型：
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作者：
Salvador-Montañés Ó;Ramirez RJ;Takemoto Y;Ennis SR;Garcia-Iglesias D;Wang S;Wolfer PJ;Jiang J;Mironov SV;Pandit SV;Jalife J;Berenfeld O
心房颤动发作时的激活知之甚少。我们的目的是开发一个全景光学标测系统的心房和测试的假设，顺序转子的基础上加速心房颤动发作期间。在0.25 µmol/L卡巴胆碱存在下，对5只绵羊心脏进行Langendorff灌注。新的光学系统记录激动同时从整个左，右心房内膜表面。20持续（>40秒）心房颤动发作诱导的列车和过早的刺激协议。分析在过早刺激后立即（起始阶段）和30秒（早期稳定阶段）获得的电影。在所有持续诱导中观察到连续转子形成，而在非持续诱导中没有观察到连续转子形成。在持续发作中，最大主频从初始时的11.5±1.74 Hz（平均值±标准差）增加到早期稳定时的14.79±1.30 Hz（P<0.0001），此后稳定。在转子部位，10次转子前激活期间的平均周期长度（CL）在启动期间每个周期增加0.53%（P=0.0303），在早期稳定期间增加0.34%（P=0.0003）。而转子部位的CL在转子出现后突然下降，平均下降9.65%（P<0.0001）。开始时，转子期间的心房范围加速和减速显示净加速结果，转子后心房范围最小CL（CLmin）为转子前CLmin的95.5±6.8%（P=0.0042）。相比之下，在早期稳定期间，在加速旋翼期间，CLmin中没有净加速度（前旋翼=84.9±11.0%，后旋翼=85.8±10.8%，P=0.4029）。转子漂移距离和速度水平与心房范围的加速度相关。非转子相位奇点不会加速心房范围内的激动，但在启动至早期稳定期间会成倍增加。奇点数量增加，表明复杂性增加，与全心房CLmin降低相关（P<0.0001）。新的心房全景光学标测显示胆碱能性房颤发作时转子部位CL缩短。房颤加速至早期稳定与漂移转子活动期间心房范围加速的净结果相关。
Activation during onset of atrial fibrillation is poorly understood. We aimed at developing a panoramic optical mapping system for the atria and test the hypothesis that sequential rotors underlie acceleration of atrial fibrillation during onset. Five sheep hearts were Langendorff perfused in the presence of 0.25 µmol/L carbachol. Novel optical system recorded activations simultaneously from the entire left and right atrial endocardial surfaces. Twenty sustained (>40 s) atrial fibrillation episodes were induced by a train and premature stimuli protocol. Movies obtained immediately (Initiation stage) and 30 s (Early Stabilization stage) after premature stimulus were analyzed. Serial rotor formation was observed in all sustained inductions and none in nonsustained inductions. In sustained episodes maximal dominant frequency increased from (mean±SD) 11.5±1.74 Hz during Initiation to 14.79±1.30 Hz at Early Stabilization (P<0.0001) and stabilized thereafter. At rotor sites, mean cycle length (CL) during 10 prerotor activations increased every cycle by 0.53% (P=0.0303) during Initiation and 0.34% (P=0.0003) during Early Stabilization. In contrast, CLs at rotor sites showed abrupt decreases after the rotors appearances by a mean of 9.65% (P<0.0001) during both stages. At Initiation, atria‐wide accelerations and decelerations during rotors showed a net acceleration result whereby post‐rotors atria‐wide minimal CL (CLmin) were 95.5±6.8% of the prerotor CLmin (P=0.0042). In contrast, during Early Stabilization, there was no net acceleration in CLmin during accelerating rotors (prerotor=84.9±11.0% versus postrotor=85.8±10.8% of Initiation, P=0.4029). Levels of rotor drift distance and velocity correlated with atria‐wide acceleration. Nonrotor phase singularity points did not accelerate atria‐wide activation but multiplied during Initiation until Early Stabilization. Increasing number of singularity points, indicating increased complexity, correlated with atria‐wide CLmin reduction (P<0.0001). Novel panoramic optical mapping of the atria demonstrates shortening CL at rotor sites during cholinergic atrial fibrillation onset. Atrial fibrillation acceleration toward Early Stabilization correlates with the net result of atria‐wide accelerations during drifting rotors activity.