Long-term frequency gradients during persistent atrial fibrillation in sheep are associated with stable sources in the left atrium.
Long-term frequency gradients during persistent atrial fibrillation in sheep are associated with stable sources in the left atrium.
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DOI：
10.1161/circep.111.969519
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发表时间：
2012-12
期刊：
影响因子：
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通讯作者：
Berenfeld O
中科院分区：
文献类型：
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作者：
Filgueiras-Rama D;Price NF;Martins RP;Yamazaki M;Avula UM;Kaur K;Kalifa J;Ennis SR;Hwang E;Devabhaktuni V;Jalife J;Berenfeld O
持续性心房颤动 (AF) 患者的心房激活的主导频率 (DF) 高于阵发性心房颤动 (AF)，并且在这两种患者中均已确定从左心房到右心房 (LA-to-RA) 的 DF 梯度。然而，随着长期持续性自动对焦的建立，这种梯度是否得以维持仍有待探索。我们的目的是确定绵羊体内从阵发性 AF 到持续性 AF 的心房 DF 值的时程，并检验 LA 至 RA DF 差异与持续性 AF 中 LA 驱动因素相关的假设。使用 RA 快速起搏诱发 AF（N=8）。每周从 RA 导线和植入在 LA 附近的循环记录器 (ILR) 获取电图。在 AF 体内和离体光学测绘期间，确定 5 秒长的电描记图（减去 QRST）的 DF。将潜在的结构变化与体重匹配的对照进行比较（N=4）。第一次 AF 发作后，DF 在 2 周内逐渐增加（7±0.21 至 9.92±0.31 Hz，N=6，p<0.05）。在 AF 9-24 周期间，ILR 上的 DF 值高于 RA（分别为 10.6±0.08 与 9.3±0.1 Hz；N=7，p<0.0001）。随后的光学测绘证实了从后 LA 到 RA 的 DF 梯度（9.1±1.0 至 6.9±0.9 Hz。p<0.05），并证明了与后 LA (PLA) 中的漂移转子兼容的激活模式。与对照组相比，持续 AF 绵羊的 PLA 显着增大。在绵羊中，从阵发性 AF 到持续性 AF 的转变显示了体内连续的 LA 到 RA DF 梯度以及 PLA 的扩大，PLA 具有与漂移转子兼容的最高频域和激活模式。
Dominant frequencies (DFs) of activation are higher in the atria of patients with persistent than paroxysmal atrial fibrillation (AF) and left-to-right atrial (LA-to-RA) DF gradients have been identified in both. However, whether such gradients are maintained as long-term persistent AF is established remains unexplored. We aimed at determining in-vivo the time-course in atrial DF values from paroxysmal to persistent AF in sheep, and test the hypothesis that a LA-to-RA DF difference is associated with LA drivers in persistent AF. AF was induced using RA tachypacing (N=8). Electrograms were obtained weekly from a RA lead and a loop recorder (ILR) implanted near the LA. DFs were determined for 5-sec-long electrograms (QRST subtracted) during AF in-vivo and in ex-vivo optical mapping. Underlying structural changes were compared to weight-matched controls (N=4). Following the first AF episode, DF increased gradually over a 2-week period (7±0.21 to 9.92±0.31 Hz, N=6, p<0.05). During 9–24 weeks of AF the DF values on the ILR were higher than the RA (10.6±0.08 vs. 9.3±0.1 Hz, respectively; N=7, p<0.0001). Subsequent optical mapping confirmed a DF gradient from posterior LA-to-RA (9.1±1.0 to 6.9±0.9 Hz. p<0.05) and demonstrated patterns of activation compatible with drifting rotors in the posterior LA (PLA). Persistent AF sheep showed significant enlargement of the PLA compared to controls. In the sheep transition from paroxysmal to persistent AF shows continuous LA-to-RA DF gradients in-vivo together with enlargement of the PLA, which harbors the highest frequency domains and patterns of activation compatible with drifting rotors.