Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease
Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease
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DOI：
10.1161/circep.109.910125
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发表时间：
2010-12-01
影响因子：
8.4
通讯作者：
Crijns, Harry J.
中科院分区：
文献类型：
--
作者：
Allessie, Maurits A.;de Groot, Natasja M. S.;Crijns, Harry J.
人类持续性心房颤动（AF）的电病理学基础在很大程度上是未知的。本研究的目的是比较正常窦性心律和长期持续性房颤患者的心房颤动过程的时空特征。（244个电极），左侧壁（LA），对24例长期持续性房颤患者进行了左心房后壁（PV）检查。25例正常窦性心律患者，其中快速起搏诱发房颤，作为参考组。开发了一种映射算法，该算法将复杂的纤颤过程分离成其单个元素（波映射）。用于表征AF基质的参数为（1）波间传导阻滞的总长度，（2）纤颤波的数量，以及（3）阻滞与纤颤波碰撞的比率（解离指数）。在4403幅持续性房颤的标测图中，没有发现稳定的病灶或转子的证据，相反，许多狭窄的小波同时通过心房壁传播。这些波的外侧边界由波间传导阻滞线形成，主要平行于心房肌肉组织。积木的线条不是固定的，而是在节拍的基础上不断变化的。在持续性房颤患者中，右心房传导阻滞的总长度比急性房颤患者高6倍以上（中位数，21.1 vs 3.4 mm/cm（2）; P < 0.0001）。波间传导阻滞程度最高的是肺静脉区（33.0 mm/cm（2））。持续性房颤的纤颤波数为4.5/cm 2，急性房颤为2.3/cm 2，分离指数为7.3比1.5（P < 0.0001）。这些参数在患者之间的个体间变异是high. Conclusions-电解离相邻的心房肌束是一个关键因素，在发展中的人类AF的基板。病理变化的程度可以测量在个人的基础上，由电生理参数在空间域。(Circ心律失常电生理学2010;3：606-615）。
Background-The electropathological substrate of persistent atrial fibrillation (AF) in humans is largely unknown. The aim of this study was to compare the spatiotemporal characteristics of the fibrillatory process in patients with normal sinus rhythm and long-standing persistent AF.Methods and Results-During cardiac surgery, epicardial mapping (244 electrodes) of the right atrium (RA), the left lateral wall (LA), and the posterior left atrium (PV) was performed in 24 patients with long-standing persistent AF. Twenty-five patients with normal sinus rhythm, in whom AF was induced by rapid pacing, served as a reference group. A mapping algorithm was developed that separated the complex fibrillation process into its individual elements (wave mapping). Parameters used to characterize the substrate of AF were (1) the total length of interwave conduction block, (2) the number of fibrillation waves, and (3) the ratio of block to collision of fibrillation waves (dissociation index). In 4403 maps of persistent AF, no evidence for the presence of stable foci or rotors was found. Instead, many narrow wavelets propagated simultaneously through the atrial wall. The lateral boundaries of these waves were formed by lines of interwave conduction block, predominantly oriented parallel to the atrial musculature. Lines of block were not fixed but continuously changed on a beat-to-beat basis. In patients with persistent AF, the total length of block in the RA was more than 6-fold higher than during acute AF (median, 21.1 versus 3.4 mm/cm(2); P < 0.0001). The highest degree of interwave conduction block was found in the PV area (33.0 mm/cm(2)). The number of fibrillation waves during persistent AF was 4.5/cm(2) compared with 2.3 during acute AF, and the dissociation index was 7.3 versus 1.5 (P < 0.0001). The interindividual variation of these parameters among patients was high.Conclusions-Electric dissociation of neighboring atrial muscle bundles is a key element in the development of the substrate of human AF. The degree of the pathological changes can be measured on an individual basis by electrophysiological parameters in the spatial domain. (Circ Arrhythm Electrophysiol. 2010;3:606-615.)