Quantifying fractionation and rate in human atrial fibrillation using monophasic action potentials: implications for substrate mapping
Quantifying fractionation and rate in human atrial fibrillation using monophasic action potentials: implications for substrate mapping
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DOI：
10.1093/europace/eum212
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发表时间：
2007-11-01
期刊：
影响因子：
6.1
通讯作者：
Franz, Michael R.
中科院分区：
文献类型：
--
作者：
Narayan, Sanjiv M.;Franz, Michael R.
目的利用单相动作电位（MAP）更好地评估心房颤动（AF）标测过程中碎裂电图的发生率和存在情况。基质标测对于房颤消融越来越重要。然而，传统的双极信号表示波形形状不佳，不清楚是否分馏反映局部波形变化，真正的电描记图碎片，或噪音，并提出问题，是否他们的频谱主频（DF）准确估计AF率。直径44 +/- 8 mm），我们研究了AF期间的49个右心房MAP时期。我们比较了使用MAP和通过过滤MAP获得的双极电描记图的分级、频谱和时域AF率估计。在双极而非MAP电描记图中，分数被高估（P = 0.005），并且经常反映MAP上的伪影。相反，MAP中的局部波形变异性（包括交替或分离）在双极电描记图中通常是一致的。测量的AF周期长度（CL）由MAP的DF准确表示（r = 0.73，P < 0.001），但由于重复计数，而不是由双极信号的DF表示（r = 0.29，P = 0.07）。因此，光谱CL估计是准确的（
Aims To use monophasic action potentials (MAPs) to better assess the rate and the presence of fractionated electrograms during the mapping of atria[ fibrillation (AF). Substrate mapping is increasingly central to AF ablation. However, traditional bipolar signals poorly represent waveform shape, making it unclear whether fractionation reflects local waveform variations, true electrogram fragmentation, or noise, and raising issues on whether their spectral dominant frequencies (DFs) accurately estimate AF rate.Methods and results In 28 patients with paroxysmal or persistent AF (left atrial. diameters 44 +/- 8 mm), we studied 49 epochs of right atrial MAPs during AF We compared fractionation, spectral and time-domain AF rate estimates using MAPs and bipolar electrograms obtained by filtering the MAPs. Fractionation was overestimated in bipolar rather than MAP electrograms (P = 0.005) and often reflected artefacts on the MAPs. Conversely, local waveform variability in the MAPs, including alternans or fractionation, was often uniform in the bipolar electrograms. The measured AF cycle length (CL) was accurately represented by the DF of the MAPs (r = 0.73, P < 0.001) but, due to double counting, not by the DF of bipolar signals (r = 0.29, P = 0.07). Spectral CL estimates were therefore accurate (