Mechanistic Comparison of “Nearly-Missed” versus “On-Target” Rotor Ablation
Mechanistic Comparison of “Nearly-Missed” versus “On-Target” Rotor Ablation
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“差点错过”与“达到目标”转子消融的机制比较
DOI：
10.1016/j.jacep.2015.04.015
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Kalifa J
中科院分区：
文献类型：
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作者：
Yamazaki M;Avula U;Berenfeld O;Kalifa J
目的：本研究使用先进的光学标测技术，在2种不同的基于电描记图的消融策略之前和之后检查房颤（AF）动力学：复杂碎裂心房电描记图（CFAE）和DFmax/转子消融。背景技术在被提出来解开使AF持续的心房区域的电描记图分析特征中，CFAE、最高主频部位（DFmax），以及最近，启用相位分析的转子映射受到了最大的关注。尽管如此，这些方法调节AF动力学并导致AF终止的机制尚不清楚。方法在兰根多夫灌注的绵羊心脏中，通过连续灌注乙酰胆碱维持AF，并从左心房记录高分辨率心内膜-心外膜光学视频自由壁和左心房后壁。然后，使用4F消融导管（5 - 15 W，30 - 60 s/点）靶向DFmax/转子区域（n = 7）或具有最高波破碎密度（HWD）的CFAE区域（n = 5）。此后，我们研究了AF动力学的变化，是否AF terminated.ResultsDFmax/转子点消融导致DFmax值显着下降。在2只动物中，AF终止，而在其余5只动物中，消融后DFmax结构域保持在其消融前位置附近。然而，在HWD/CFAE密度消融后，DFmax值没有改变，AF没有终止，并且消融后DFmax域从左心房游离壁重新定位到肺静脉-左心房后区。在另一组心脏（n = 12），我们观察到，在乙酰胆碱浓度的逐步增加，模仿消融后发生的急性电生理变化-三维转子漂移从一个心房区域到另一个沿着大梯度的心肌thicken.Conclusions“目标”DFmax/转子消融导致的颤动驱动转子的湮灭。这转化为AF频率或AF终止的大幅降低。相比之下，“几乎错过”的HWD/CFAE消融保留了原纤化驱动转子，并为转子沿沿着大心肌厚度梯度漂移创造了条件。
ObjectivesThis study used advanced optical mapping techniques to examine atrial fibrillation (AF) dynamics before and after 2 distinct electrogram-based ablation strategies: complex fractionated atrial electrograms (CFAEs) and DFmax/rotor ablation.BackgroundAmong the electrogram analytical features proposed to unravel the atrial regions that perpetuate AF, CFAEs, highest dominant frequency sites (DFmax), and, more recently, phase analysis-enabled rotor mapping have received the largest attention. Still, the mechanisms by which these approaches modulate AF dynamics and lead to AF termination are unknown.MethodsIn Langendorff-perfused sheep hearts, AF was maintained by the continuous perfusion of acetylcholine and high-resolution endocardial-epicardial optical videos were recorded from the left atrial free wall and the posterior left atrium. Then, DFmax/rotor regions (n = 7), or CFAE regions harboring the highest wavebreak density (HWD) (n = 5), were targeted with a 4F ablation catheter (5 to 15 W, 30 to 60 s/point). Thereafter, we examined the changes in AF dynamics and whether AF terminated.ResultsDFmax/rotor point ablation resulted in a significant decrease in DFmax values. In 2 animals AF terminated, whereas in the remaining 5 animals the post-ablation DFmax domain remained in the vicinity of its pre-ablation location. However, after HWD/CFAEs density ablation, DFmax values did not change, AF did not terminate, and post-ablation DFmax domains relocated from the left atrial free wall to the pulmonary vein–posterior left atrium region. In another group of hearts (n = 12), we observed that upon a progressive increase in acetylcholine concentration—mimicking the acute electrophysiological changes occurring after ablation—3-dimensional rotors drifted from one atrial region to another along large gradients of myocardial thickness.Conclusions“On-target” DFmax/rotor ablation leads to the annihilation of the fibrillation-driving rotor. This translates into large decreases in AF frequency or AF termination. In contrast, “nearly missed” HWD/CFAEs ablation spares the fibrillation-driving rotor, and set the stage for rotor drift along large myocardial thickness gradients.