A Novel Mapping System for Panoramic Mapping of the Left Atrium Application to Detect and Characterize Localized Sources Maintaining Atrial Fibrillation
A Novel Mapping System for Panoramic Mapping of the Left Atrium Application to Detect and Characterize Localized Sources Maintaining Atrial Fibrillation
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DOI：
10.1016/j.jacep.2017.09.177
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发表时间：
2018-01-01
影响因子：
7
通讯作者：
Hunter, Ross J.
中科院分区：
文献类型：
--
作者：
Honarbakhsh, Shohreh;Schilling, Richard J.;Hunter, Ross J.
目的 本研究试图使用一种新型全景测绘系统 (CARTOFINDER) 来检测和描述持续性心房颤动 (AF) 的驱动因素。背景持续性房颤的维持机制仍不确定。方法纳入因持续性房颤而接受导管消融的患者。 64 极篮式导管用于采集单极信号，这些信号由绘图系统处理以生成波前传播图。该系统用于识别和表征 AF 肺静脉 (PV) 隔离前后的潜在驱动因素。评估了消融对 PV 隔离后确定的驾驶员的影响。 结果 研究纳入了 20 名患者，创建了 112 张 CARTOFINDER 地图。对 20 名 AF 患者中的 19 名绘制了潜在驱动因素图（1 名患者存在篮子损坏和电图噪音）。确定了 30 个潜在驱动因素，所有这些驱动因素都是短暂但重复的； 19 个是旋转的，11 个是焦点的。 26 名驾驶员中，有 22 名驾驶员中的 26 名驾驶员被消融，其中 12 名驾驶员终止了 AF，10 名驾驶员周期长度减慢（>= 30 毫秒）。具有旋转激活的驾驶员主要映射到低电压区域的位置（81.8%）。 PV 隔离对驱动部位的周期长度没有显着影响（PV 隔离前为 138.4 +/- 14.3 ms，PV 隔离后为 137.2 +/- 15.2 ms），并且在 PV 隔离前图上识别的驱动因素更常见与 AF 终止相关。 结论 在几乎所有患者中，驱动因素均以间歇性但重复的局灶性或旋转激活模式的形式被识别。对消融的反应证实了这些现象的机械重要性。 (c) 2018 年作者。由爱思唯尔代表美国心脏病学会基金会出版。这是一篇基于 CC BY 许可证 (http://creativecommons.org/licenses/by/4.0/) 的开放获取文章。
OBJECTIVES This study sought to use a novel panoramic mapping system (CARTOFINDER) to detect and characterize drivers in persistent atrial fibrillation (AF).BACKGROUND Mechanisms sustaining persistent AF remain uncertain.METHODS Patients undergoing catheter ablation for persistent AF were included. A 64-pole basket catheter was used to acquire unipolar signals, which were processed by the mapping system to generate wavefront propagation maps. The system was used to identify and characterize potential drivers in AF pre- and post-pulmonary vein (PV) isolation. The effect of ablation on drivers identified post-PV isolation was assessed.RESULTS Twenty patients were included in the study with 112 CARTOFINDER maps created. Potential drivers were mapped in 19 of 20 patients with AF (damage to the basket and noise on electrograms was present in 1 patient). Thirty potential drivers were identified all of which were transient but repetitive; 19 were rotational and 11 focal. Twenty-six drivers were ablated with a predefined response in 22 of 26 drivers: AF terminated with 12 and cycle length slowed (>= 30 ms) with 10. Drivers with rotational activation were predominantly mapped to sites of low-voltage zones (81.8%). PV isolation had no remarkable impact on the cycle length at the driver sites (138.4 +/- 14.3 ms pre-PV isolation vs. 137.2 +/- 15.2 ms post-PV isolation) and drivers that had also been identified on pre-PV isolation maps were more commonly associated with AF termination.CONCLUSIONS Drivers were identified in almost all patients in the form of intermittent but repetitive focal or rotational activation patterns. The mechanistic importance of these phenomena was confirmed by the response to ablation. (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).