Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method
Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method
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DOI：
10.1016/j.jacep.2019.04.007
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发表时间：
2019-07-01
影响因子：
7
通讯作者：
Schilling, Richard J.
中科院分区：
文献类型：
--
作者：
Honarbakhsh, Shohreh;Hunter, Ross J.;Schilling, Richard J.
结论：本研究的目的是证明随机向量标测方法可以指导房颤（AF）驱动器的消融，消融反应和长期随访outcome.Background AF驱动器的标测和消融的最佳方法尚未被定义。患者接受肺静脉隔离（PVI），并在随机轨迹分析（星星）标测方法指导下进行进一步消融。电极的激活被视为先于其相邻电极激活的时间的比例用于确定早期激活位点（ESA）。ESA的阳性消融反应定义为AF终止或周期长度减慢>= 30 ms。临床结果定义为随访12个月期间AF/房性心动过速（AT）复发。肺静脉隔离后，每例患者平均消融2.6 +/-0.8 ESA，所有患者均达到研究定义的消融反应。在PVI后创建的86张星星地图中，在73.8 +/-26.1%的地图上识别出相同的ESA。导致AF终止的ESA在肺静脉隔离前后的标测图上比与周期长度装载相关的标测图上更容易识别（24例中的23例vs. 49例中的16例; p <0.001）。在18.5 +/-3.7个月的随访中，28例（80%）患者无AF/AT。结论ESA的消融反应表明，他们可能是AF的驱动因素。星星标测引导的消融产生了良好的临床结局，并通过随机对照试验进行了测试。(C)2019作者由爱思唯尔代表美国心脏病学会基金会出版。
OBJECTIVES The aim of this study was to demonstrate that a stochastic vector-based mapping approach could guide ablation of atrial fibrillation (AF) drivers as evidenced by ablation response and long-term follow-up outcomes.BACKGROUND The optimal method for mapping and ablation of AF drivers is yet to be defined.METHODS Patients undergoing persistent AF ablation were recruited. Patients underwent pulmonary vein isolation (PVI) with further ablation guided by the stochastic trajectory analysis of ranked signals (STAR) mapping method. The proportion of the time an electrode's activation was seen to precede its neighboring electrodes activation was used to determine early sites of activation (ESA). A positive ablation response at ESA was defined as AF termination or cycle length slowing of >= 30 ms. Clinical outcome was defined as recurrence of AF/atrial tachycardia (AT) during a follow-up of 12 months.RESULTS Thirty-five patients were included (AF duration of 14.4 +/- 5.3 months). After PVI, an average of 2.6 +/- 0.8 ESA were ablated per patient with study-defined ablation response achieved in all patients. Of the 86 STAR maps created post-PVI, the same ESA was identified on 73.8 +/- 26.1% of maps. ESA that resulted in AF termination were more likely to be identified on both pre- and post-PVI maps than those associated with cycle length stowing (23 of 24 vs. 16 of 49; p < 0.001). During a follow-up of 18.5 +/- 3.7 months, 28 (80%) patients were free from AF/AT.CONCLUSIONS The ablation response at ESA suggests they may be drivers of AF. Ablation guided by STAR mapping produced a favorable clinical outcome and warrants testing through a randomized controlled trial. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.