Hierarchical Schema for Identifying FocalElectrical Sources During HumanAtrial Fibrillation: Implications for Catheter-Based Atrial Substrate Ablation.
Hierarchical Schema for Identifying FocalElectrical Sources During HumanAtrial Fibrillation: Implications for Catheter-Based Atrial Substrate Ablation.
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DOI：
10.1016/j.jacep.2016.02.009
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发表时间：
2016-11-01
期刊：
影响因子：
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通讯作者：
Chauhan, Vijay S
中科院分区：
文献类型：
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作者：
Gizurarson, Sigfus;Dalvi, Rupin;Chauhan, Vijay S
目的：该研究试图通过周期性成分分析（PiCA）和QS单极电图（EGM）形态学来定位心房颤动（AF）期间的病灶源（FS），该假设基于离心传播的周期性激活是心房颤动（AF）固有的。背景：由于传统时频域分析的局限性，维持AF的FS定位仍然具有挑战性。这与确定AF基底消融的目标有关。方法：41例患者（年龄56±9岁，76%为持续性房颤），在房颤期间使用20极导管在左心房（LA）记录双极egm。用PiCA测定具有周期性的双极EGMs。FS被定义为以QS单极EGM形态为主的周期性位点。结果：每例患者记录456±109次双相egm，其中261±15次（60%）表现为周期性。63%的患者出现FS（肺静脉[PV] 1.5±1.5；外PV 2.6±2.3）。经PV心房消融术后随访14±9个月，37%的患者出现房颤症状复发。房颤复发患者的平均LA周期长度比无房颤复发患者短（143±20 ms比154±9 ms； p= 0.02）。在12例（29%）仅在PV的FS患者中，只有1例（8%）有AF复发。14例（34%）pv外FS患者的房颤复发率显著增高（50%;p= 0.01）。结论：我们新的分层分析模式，结合PiCA和单极EGM形态，在主要持续性房颤患者中检测到少量FS。PV中的FS与成功的PV心房消融相关。需要进一步的前瞻性研究来确定这些FS是否维持房颤并代表消融目标。
OBJECTIVES: The study sought to localize focal sources (FS) during atrial fibrillation (AF) using periodic component analysis (PiCA) and QS unipolar electrogram (EGM) morphology based on the assumption that periodic activation with centrifugal propagation is inherent to a FS.BACKGROUND: The localization of FS maintaining AF remains challenging, due to limitations in conventional time-frequency domain analysis. This is relevant to identifying targets for AF substrate ablation.METHODS: In 41 patients (age 56 ± 9 years, 76% persistent AF), bipolar EGMs were recorded in the left atrium (LA) during AF with a roving 20-pole catheter. Bipolar EGMs with periodicity were determined using PiCA. FS were defined as periodic sites with predominantly QS unipolar EGM morphology.RESULTS: For each patient, 456 ± 109 bipolar EGMs were recorded, of which 261 ± 15 (60%) demonstrated periodicity. FS were identified in 63% of patients (pulmonary vein [PV] 1.5 ± 1.5; extra-PV 2.6 ± 2.3). After PV antral ablation and follow-up of 14 ± 9 months, 37% of patients had symptomatic AF recurrence. Mean global LA periodicity cycle length was shorter in patients with AF recurrence compared to those without (143 ± 20 ms vs. 154 ± 9 ms; p= 0.02). Among 12 (29%) patients with FS exclusively in the PV, only 1 (8%) had AF recurrence. AF recurrence was significantly higher (50%;p= 0.01) in 14 (34%) patients with extra-PV FS.CONCLUSIONS: Our novel hierarchical analysis schema, incorporating PiCA and unipolar EGM morphology, detected a smallnumber of FS in patients with predominantly persistent AF. FS in the PV was associated with successful PV antral ablation. Further prospective studies are required to determine whether these FS maintain AF and represent ablation targets.