Rotors Detected by Phase Analysis of Filtered, Epicardial Atrial Fibrillation Electrograms Colocalize With Regions of Conduction Block
Rotors Detected by Phase Analysis of Filtered, Epicardial Atrial Fibrillation Electrograms Colocalize With Regions of Conduction Block
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DOI：
10.1161/circep.117.005858
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发表时间：
2018-10-01
影响因子：
8.4
通讯作者：
Schotten, Ulrich
中科院分区：
文献类型：
--
作者：
Podziemski, Piotr;Zeemering, Stef;Schotten, Ulrich
背景：最近的几项研究表明，通过相位映射检测到的转子可能是持续性心房颤动的主要驱动因素。然而，检测到的转子的电生理性质仍不清楚。我们在人类心房颤动的高密度、心外膜、直接接触映射文件中对相位和激活时间映射进行了直接、1:1 的比较。方法：使用放置在左心房后壁或右心房游离壁心外膜表面的 16x16 电极阵列，记录房颤患者（n=20 名患者）38 个持续 10 秒的单极电图文件。为所有记录构建了相位图和等时线波图。对于每个检测到的寿命 >1 个周期长度的相位奇点 (PS)，在等时线波图中研究相应的传导模式。结果：当使用正弦重组和希尔伯特变换时，检测到 138 个 PS。 138 个 PS 中的 104 个是在距激活映射检测到的非旋转波前之间的传导块线 1 个电极距离 (1.5 mm) 内检测到的。当基于波映射识别旋转活动时，检测到的旋转波前要少得多（检测到的 8219 个波中有 18 个）。这 18 例中有 14 例在相位映射中被检测为 PS。由传导阻滞分离的模拟波前产生的滤波电描记图的相位分析也识别出传导阻滞线上的PS。结论：通过滤波心外膜电描记图的相位分析识别的PS与激活映射识别的传导阻滞线共定位。使用相位分析检测 PS 对于使用激活映射识别人类心房颤动期间的旋转波前具有较低的特异性。
BACKGROUND: Several recent studies suggest rotors detected by phase mapping may act as main drivers of persistent atrial fibrillation. However, the electrophysiological nature of detected rotors remains unclear. We performed a direct, 1:1 comparison between phase and activation time mapping in high-density, epicardial, direct-contact mapping files of human atrial fibrillation.METHODS: Thirty-eight unipolar electrogram files of 10 s duration were recorded in patients with atrial fibrillation (n=20 patients) using a 16x16 electrode array placed on the epicardial surface of the left atrial posterior wall or the right atrial free wall. Phase maps and isochrone wave maps were constructed for all recordings. For each detected phase singularity (PS) with a lifespan of >1 cycle length, the corresponding conduction pattern was investigated in the isochrone wave maps.RESULTS: When using sinusoidal recomposition and Hilbert Transform, 138 PSs were detected. One hundred and four out of 138 PSs were detected within 1 electrode distance (1.5 mm) from a line of conduction block between nonrotating wavefronts detected by activation mapping. Far fewer rotating wavefronts were detected when rotating activity was identified based on wave mapping (18 out of 8219 detected waves). Fourteen out of these 18 cases were detected as PSs in phase mapping. Phase analysis of filtered electrograms produced by simulated wavefronts separated by conduction block also identified PSs on the line of conduction block.CONCLUSIONS: PSs identified by phase analysis of filtered epicardial electrograms colocalize with conduction block lines identified by activation mapping. Detection of PSs using phase analysis has a low specificity for identifying rotating wavefronts during human atrial fibrillation using activation mapping.