Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation.
Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation.
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DOI：
10.1093/europace/euac026
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发表时间：
2022-07-15
期刊：
影响因子：
6.1
通讯作者：
Schotten, Ulrich
中科院分区：
文献类型：
--
作者：
Maesen, Bart;Verheule, Sander;Zeemering, Stef;La Meir, Mark;Nijs, Jan;Lumeij, Stijn;Lau, Dennis H.;Granier, Mathieu;Crijns, Harry Jgm;Maessen, Jos G.;Dhein, Stefan;Schotten, Ulrich
虽然在持续性房颤（AF）中，以传导阻滞发生率高为特征的复杂AF基质已被报道，但阵发性AF（pAF）中AF复杂性的相关信息相对较少。此外，结构改变的各个方面对传导干扰的相对贡献尚不清楚。特别是，肌内膜纤维化在房颤进展过程中对传导障碍的作用尚未研究。在心脏手术期间，对急性诱发（aAF，n = 11）、pAF（n = 12）和长期持续性AF（persAF，n = 9）患者的右心房（RA）壁、左心房后壁（pLA）和左心房附件（LAA）进行心外膜高密度标测。在RA附件中，对总体和肌内膜（肌细胞间距离）纤维化和连接蛋白43（Cx43）分布进行定量。单极AF电描记图分析显示，与aAF和pAF相比，persAF具有更复杂的模式，具有更多的窄波，更多的突破和更高的分馏指数（FI），aAF和pAF之间无差异。与RA相比，pLA的FI始终较高。在结构上，Cx43的偏侧化随着AF进展而增加（aAF = 7.5 ± 8.9%，pAF = 24.7 ± 11.1%，persAF = 35.1 ± 11.4%，P < 0.001）。肌内膜纤维化而非整体纤维化与AF复杂性相关（分别为r = 0.57，P = 0.001; r = 0.23，P = 0.20）。房颤复杂性在pAF患者中高度可变，但并不显著高于急性诱发AF患者，而持续性AF患者的复杂性更高。在所研究的结构改变中，肌内膜纤维化，而不是整体纤维化，是AF复杂性的最强决定因素。
Although in persistent atrial fibrillation (AF) a complex AF substrate characterized by a high incidence of conduction block has been reported, relatively little is known about AF complexity in paroxysmal AF (pAF). Also, the relative contribution of various aspects of structural alterations to conduction disturbances is not clear. In particular, the contribution of endomysial fibrosis to conduction disturbances during progression of AF has not been studied yet. During cardiac surgery, epicardial high-density mapping was performed in patients with acutely induced (aAF, n = 11), pAF (n = 12), and longstanding persistent AF (persAF, n = 9) on the right atrial (RA) wall, the posterior left atrial wall (pLA) and the LA appendage (LAA). In RA appendages, overall and endomysial (myocyte-to-myocyte distances) fibrosis and connexin 43 (Cx43) distribution were quantified. Unipolar AF electrogram analysis showed a more complex pattern with a larger number of narrower waves, more breakthroughs and a higher fractionation index (FI) in persAF compared with aAF and pAF, with no differences between aAF and pAF. The FI was consistently higher at the pLA compared with the RA. Structurally, Cx43 lateralization increased with AF progression (aAF = 7.5 ± 8.9%, pAF = 24.7 ± 11.1%, persAF = 35.1 ± 11.4%, P < 0.001). Endomysial but not overall fibrosis correlated with AF complexity (r = 0.57, P = 0.001; r = 0.23, P = 0.20; respectively). Atrial fibrillation complexity is highly variable in patients with pAF, but not significantly higher than in patients with acutely induced AF, while in patients with persistent AF complexity is higher. Among the structural alterations studied, endomysial fibrosis, but not overall fibrosis, is the strongest determinant of AF complexity.
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影响因子：
10.8
作者：
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通讯作者：
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DOI：
10.1111/j.1540-8159.1997.tb06199.x
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