Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
Computational Mapping Identifies Localized Mechanisms for Ablation of Atrial Fibrillation
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DOI：
10.1371/journal.pone.0046034
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发表时间：
2012-09-26
期刊：
影响因子：
3.7
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
心房颤动（AF）是西方世界最常见的心律失常，也是住院和死亡的常见原因。药物和非药物治疗的成功率有限，部分原因是对AF的潜在机制的理解不完全。AF传统上以时空无序的电激活为特征，尽管描述了AF的起始触发，但不清楚AF是否由空间蜿蜒的连续兴奋维持（折返波）、心房内的局部电源或一些其他机制。这限制了这种情况的治疗选择。在这里，我们表明，人类AF主要是由少量（1.8 +/- 0.9）局部折返波或重复局灶性搏动引起的，这些波或搏动在长时间内保持稳定，空间迁移有限。选择性靶向这些来源部位的射频消融能够立即终止房颤并消除心律失常，并取得了很高的成功率。我们的研究结果表明，人类AF，尽管明显的时空紊乱，往往是永久的一些空间限制和时间保守的来源，其有针对性的消融可以消除这种复杂的节律紊乱。
Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world and a common cause of hospitalization and death. Pharmacologic and non-pharmacologic therapies have met with limited success, in part due to an incomplete understanding of the underlying mechanisms for AF. AF is traditionally characterized by spatiotemporally disorganized electrical activation and, although initiating triggers for AF are described, it is unclear whether AF is sustained by spatially meandering continuous excitation (re-entrant waves), localized electrical sources within the atria, or some other mechanism. This has limited therapeutic options for this condition. Here we show that human AF is predominantly caused by a small number (1.8 +/- 0.9) of localized re-entrant waves or repetitive focal beats, that remain stable with limited spatial migration over prolonged periods of time. Radiofrequency ablation that selectively targeted the sites of these sources was able to immediately terminate fibrillation and eliminate the arrhythmia with high success. Our results show that human AF, despite apparent spatiotemporal disorganization, is often perpetuated by a few spatially-constrained and temporally conserved sources whose targeted ablation can eliminate this complex rhythm disorder.