Direct Proof of Endo-Epicardial Asynchrony of the Atrial Wall During Atrial Fibrillation in Humans
Direct Proof of Endo-Epicardial Asynchrony of the Atrial Wall During Atrial Fibrillation in Humans
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DOI：
10.1161/circep.115.003648
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发表时间：
2016-05-01
影响因子：
8.4
通讯作者：
Allessie, Maurits
中科院分区：
文献类型：
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作者：
de Groot, Natasja;van der Does, Lisette;Allessie, Maurits
背景-房颤（AF）期间局灶性颤动波的存在，除了异位活动之外，还可以通过心房内膜和心外膜层的异步激活以及透壁传播颤动波来解释。为了提供心外膜异步性的直接证据，我们在人类 AF 期间对右心房内壁和心外膜壁进行了同步高分辨率标测。 方法和结果 - 在 10 名 AF 患者（阵发性：n=3；持续性：n=4；长期存在）AF 期间（诱导）进行了右心房壁和心外膜壁的术中标测。 持续性：n=3) 和 4 名无 AF 病史的患者。将由 2 个矩形 8x16 电极阵列（电极间距离 2 mm）制成的夹子插入右心耳的切口。分析 10 秒 AF 的记录，以确定相对电极的异步心外膜激活时间（>= 15 ms）的发生率。异步心外膜激活范围在 0.9% 到 55.9% 之间，没有任何一侧的偏好。心内膜和心外膜的焦波出现频率相同（11% 与 13%；P=0.18）。使用严格的突破标准（4 毫米内存在相反的波并且
Background-The presence of focal fibrillation waves during atrial fibrillation (AF) can, besides ectopic activity, also be explained by asynchronous activation of the atrial endo-and epicardial layer and transmurally propagating fibrillation waves. To provide direct proof of endo-epicardial asynchrony, we performed simultaneous high-resolution mapping of the right atrial endo-and epicardial wall during AF in humans.Method and Results-Intraoperative mapping of the endo-and epicardial right atrial wall was performed during (induced) AF in 10 patients with AF (paroxysmal: n=3; persistent: n=4; and longstanding persistent: n=3) and 4 patients without a history of AF. A clamp made of 2 rectangular 8x16 electrode arrays (interelectrode distance 2 mm) was inserted into the incision in the right atrial appendage. Recordings of 10 seconds of AF were analyzed to determine the incidence of asynchronous endo-epicardial activation times (>= 15 ms) of opposite electrodes. Asynchronous endo-epicardial activation ranged between 0.9 and 55.9% without preference for either side. Focal waves appeared equally frequent at endocardium and epicardium (11% versus 13%; P=0.18). Using strict criteria for breakthrough (presence of an opposite wave within 4 mm and