Effects of two different catheter ablation techniques on spectral characteristics of atrial fibrillation
Effects of two different catheter ablation techniques on spectral characteristics of atrial fibrillation
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DOI：
10.1016/j.jacc.2006.04.053
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发表时间：
2006-07-18
影响因子：
24
通讯作者：
Oral, Hakan
中科院分区：
文献类型：
--
作者：
Lemola, Kristina;Ting, Michael;Oral, Hakan
本研究的目的是确定环肺静脉消融（CPVA）和电图引导消融（EGA）对心房颤动（AF）频谱特征的影响，以及主频（DF）变化与临床结局的关系。背景环肺静脉消融和EGA已用于消除AF。频谱分析可以识别高频率的房颤（AF）。方法对84例阵发性房颤（49例）和持续性房颤（35例）患者进行了CPVA（42例）或EGA（42例）。结果持续性房颤患者的左房DF（5.83 ± 0.86 Hz）高于阵发性房颤患者（5.33 ± 0.76 Hz，p = 0.03）。从左心房到冠状窦存在频率梯度（p = 0.02）。环肺静脉消融和EGA导致DF相似降低（18 +/- 17% vs. 17 +/-15%，p = 0.8）。在平均9 +/-6个月的随访中，有和无复发性AF的患者在CPVA后DF的变化相似。EGA后DF的急性降低仅与持续性AF患者的无复发性AF相关（19 +/-14%vs.3 +/-6%，p = 0.02）.结论CPVA和EGA均降低AF的DF，与消除高频源一致。尽管EGA的疗效与持续性AF患者的DF降低相关，但CPVA的疗效与DF变化无关。这表明CPVA和EGA消除持续性AF发生的不同机制。
OBJECTIVES The aim of this study was to determine the effects of circumferential pulmonary vein ablation (CPVA) and electrogram-guided ablation (EGA) on the spectral characteristics of atrial fibrillation (AF) and the relationship between changes in dominant frequency (DF) and clinical outcome.BACKGROUND Circumferential pulmonary vein ablation and EGA have been used to eliminate AF. Spectral analysis may identify high-frequency sources.METHODS In 84 consecutive patients, CPVA (n = 42) or EGA (n 42) was performed for paroxysmal (n = 49) or persistent (n = 35) AF. During EGA, complex electrograms were targeted. Lead V-1 and electrograms from the left atrium and coronary sinus were analyzed to determine the DF of AF before and after ablation.RESULTS The left atrial DF was higher in persistent (5.83 +/- 0.86 Hz) than paroxysmal AF (5.33 +/- 0.76 Hz, p = 0.03). There was a frequency gradient from the left atrium to the coronary sinus (p = 0.02). Circumferential pulmonary vein ablation and EGA resulted in a similar decrease in DF (18 +/- 17% vs. 17 +/- 15%, p = 0.8). During a mean follow-up of 9 +/- 6 months, the change in DF after CPVA was similar among patients with and without recurrent AF. An acute decrease in DF after EGA was associated with freedom from recurrent AF only in patients with persistent AF (19 +/- 14% vs. 3 +/- 6%, p = 0.02).CONCLUSIONS Both CPVA and EGA decrease the DF of AF, consistent with elimination of high-frequency sources. Whereas the efficacy of EGA is associated with a decrease in DF in patients with persistent AF, the efficacy of CPVA is independent of changes in DF. This suggests that CPVA and EGA eliminate different mechanisms in the genesis of persistent AF.