Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation.
Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation.
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DOI：
10.1016/j.hrthm.2018.07.019
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发表时间：
2019-01
期刊：
影响因子：
5.5
通讯作者：
Hunter RJ
中科院分区：
文献类型：
--
作者：
Honarbakhsh S;Schilling RJ;Orini M;Providencia R;Keating E;Finlay M;Sporton S;Chow A;Earley MJ;Lambiase PD;Hunter RJ
频率依赖性传导速度（CV）减慢与心房颤动（AF）启动和折返机制相关。本研究旨在评估双极电压、CV动力学和AF驱动因素之间的关系。入选因持续性房颤（<24个月）接受导管消融术的患者。采用64极篮状导管记录窦性心律下4个起搏间期（PI）心房起搏时的单极电图。沿波阵面路径沿着测量极对之间的CV，并将其与基础双极电压相关联。将低压区（LVZ <0.5 mV）内的CV动力学与非LVZ（≥0.5 mV）内的CV动力学进行比较，并将其与使用CARTOFINDER（Biosense韦伯斯特）绘制的驱动位点相关。纳入18例患者（年龄62 ± 10岁）。600 ms时，非LVZ组的平均CV为1.59 ± 0.13 m/s，LVZ组为0.98 ± 0.23 m/s（P <0.001）。在LVZ中，CV在所有4个PI上逐渐降低，而在非LVZ中，CV仅在PI 300-250 ms之间显著降低（0.59 ± 0.09 m/s; P <.001）。心率依赖性CV减慢部位测量值（定义为CV降低≥20%，超过该电压区PI 600-250 ms之间观察到的平均CV降低）主要位于LVZ（0.2-0.5 mV; 75.6% ± 15.5%; P <.001）。在94.1%的病例中，确认的旋转驱动器映射到这些部位（灵敏度94.1%，95% CI 71.3%-99.9%;特异性77.9%，95% CI 74.9%-80.7%）。CV动力学主要由重构的程度决定。心率依赖性CV减慢位点主要局限于LVZ（0.2-0.5 mV），由此产生的CV异质性可能促进AF中驱动因子的形成。
Rate-dependent conduction velocity (CV) slowing is associated with atrial fibrillation (AF) initiation and reentrant mechanisms. The purpose of this study was to assess the relationship between bipolar voltage, CV dynamics, and AF drivers. Patients undergoing catheter ablation for persistent AF (<24 months) were enrolled. Unipolar electrograms were recorded with a 64-pole basket catheter during atrial pacing at 4 pacing intervals (PIs) during sinus rhythm. CVs were measured between pole pairs along the wavefront path and correlated with underlying bipolar voltage. CV dynamics within low-voltage zones (LVZs <0.5 mV) were compared to those of non-LVZs (≥0.5 mV) and were correlated to driver sites mapped using CARTOFINDER (Biosense Webster). Eighteen patients were included (age 62 ± 10 years). Mean CV at 600 ms was 1.59 ± 0.13 m/s in non-LVZs vs 0.98 ± 0.23 m/s in LVZs (P <.001). CV decreased incrementally over all 4 PIs in LVZs, whereas in non-LVZs a substantial decrease in CV was only seen between PIs 300–250 ms (0.59 ± 0.09 m/s; P <.001). Rate-dependent CV slowing sites measurements, defined as exhibiting CV reduction ≥20% more than the mean CV reduction seen between PIs 600–250 ms for that voltage zone, were predominantly in LVZs (0.2–0.5 mV; 75.6% ± 15.5%; P <.001). Confirmed rotational drivers were mapped to these sites in 94.1% of cases (sensitivity 94.1%, 95% CI 71.3%–99.9%; specificity 77.9%, 95% CI 74.9%–80.7%). CV dynamics are determined largely by the extent of remodeling. Rate-dependent CV slowing sites are predominantly confined to LVZs (0.2–0.5 mV), and the resultant CV heterogeneity may promote driver formation in AF.
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影响因子：
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