AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach.
AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach.
复制标题
AF消融在没有肺静脉隔离的时空电动图分散剂的指导下：一种完全的患者监测方法。
DOI：
10.1016/j.jacc.2016.10.065
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发表时间：
2017-01-24
影响因子：
24
通讯作者：
Kalifa J
中科院分区：
文献类型：
--
作者：
Seitz J;Bars C;Théodore G;Beurtheret S;Lellouche N;Bremondy M;Ferracci A;Faure J;Penaranda G;Yamazaki M;Avula UM;Curel L;Siame S;Berenfeld O;Pisapia A;Kalifa J
使用心内电描记图指导房颤（AF）消融产生了相互矛盾的结果。我们评估了AF驱动器的电描记图标记：表现出时空分散的电描记图的聚类-无论这些电描记图是否被分割。为了评估时空离散度（AF驱动器的视觉可识别电足迹）对所有形式AF消融的有用性，我们前瞻性招募了105例接受AF消融的患者。使用20极PentaRay导管在两个心房中顺序标测AF。我们标记和消融只有区域显示电描记图分散在AF。结果进行了比较，其中使用传统的消融方法（肺静脉隔离/逐步的方法）的验证集。为了建立AF电描记图时空分散的机制，我们在2维模型和羊心房瘢痕相关AF的光学标测中对AF驱动程序进行了逼真的数值模拟。分散区域的消融终止了95%的AF。消融17±10%的左心房表面并随访18个月后，1.4±0.5次手术/患者后房性心律失常复发率为15%，而验证集1.5±0.5次手术/患者后房性心律失常复发率为41%（无心律失常生存率：85% vs 59%，对数秩P<0.001）。与验证集相比，射频时间（49 ± 21分钟vs 85 ± 34.5分钟，p=0.001）和手术时间（168 ± 42分钟vs 230 ± 67分钟，p<0.0001）更短。在模拟和光学标测实验中，虚拟PentaRay记录表明，电描记图分散主要记录在驾驶员附近。表现出时空分散的心内电描记图的聚类指示AF驱动器。其消融允许非广泛和患者定制的AF消融方法。临床trial.gov编号：NCT 02093949
The use of intra-cardiac electrograms to guide atrial fibrillation (AF) ablation has yielded conflicting results. We evaluated an electrogram marker of AF drivers: the clustering of electrograms exhibiting spatio-temporal dispersion — regardless of whether such electrograms were fractionated or not. To evaluate the usefulness of spatio-temporal dispersion, a visually recognizable electric footprint of AF drivers, for the ablation of all forms of AF. We prospectively enrolled 105 patients admitted for AF ablation. AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. We tagged and ablated only regions displaying electrogram dispersion during AF. Results were compared to a validation set in which a conventional ablation approach was used (pulmonary vein isolation/stepwise approach). To establish the mechanism underlying spatio-temporal dispersion of AF electrograms, we conducted realistic numerical simulations of AF drivers in a 2-dimensional model and optical mapping of ovine atrial scar-related AF. Ablation at dispersion areas terminated AF in 95%. After ablation of 17±10% of the left atrial surface and 18 months of follow-up, the atrial arrhythmia recurrence rate was 15% after 1.4±0.5 procedure/patient vs 41% in the validation set after 1.5±0.5 procedure/patient (arrhythmia free-survival rates: 85% vs 59%, log rank P<0.001). In comparison with the validation set, radiofrequency times (49 ± 21 minutes vs 85 ± 34.5 minutes, p=0.001) and procedure times (168 ± 42 minutes vs. 230 ± 67 minutes, p<.0001) were shorter. In simulations and optical mapping experiments, virtual PentaRay recordings demonstrated that electrogram dispersion is mostly recorded in the vicinity of a driver. The clustering of intra-cardiac electrograms exhibiting spatio-temporal dispersion is indicative of AF drivers. Their ablation allows for a non-extensive and patient-tailored approach to AF ablation. Clinical trial.gov number: NCT02093949
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影响因子：
20.1
作者：
Ashihara T;Haraguchi R;Nakazawa K;Namba T;Ikeda T;Nakazawa Y;Ozawa T;Ito M;Horie M;Trayanova NA
通讯作者：
Trayanova NA
影响因子：
24
作者：
Jadidi, Amir S.;Cochet, Hubert;Jais, Pierre
通讯作者：
Jais, Pierre
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Miller, John M.
通讯作者：
Miller, John M.
影响因子：
37.8
作者：
Oral, Hakan;Chugh, Aman;Morady, Fred
通讯作者：
Morady, Fred
影响因子：
8.4
作者：
Scherr, Daniel;Khairy, Paul;Jais, Pierre
通讯作者：
Jais, Pierre