Organized Sources Are Spatially Conserved in Recurrent Compared to Pre-Ablation Atrial Fibrillation: Further Evidence for Non-Random Electrical Substrates
Organized Sources Are Spatially Conserved in Recurrent Compared to Pre-Ablation Atrial Fibrillation: Further Evidence for Non-Random Electrical Substrates
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DOI：
10.1111/jce.12964
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发表时间：
2016-06-01
影响因子：
2.7
通讯作者：
Narayan, Sanjiv M.
中科院分区：
文献类型：
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作者：
Lalani, Gautam G.;Coysh, Thomas;Narayan, Sanjiv M.
复发性房颤中保留的转子简介消融后复发性房颤（AF）与最初孤立的肺静脉（PV）触发部位重新连接有关。除肺静脉隔离外，基质也常作为目标，但基质如何随时间推移而发展尚不清楚。我们研究了复发性AF的基质是保守的还是从消融前AF重新发展而来的。方法和结果在137例接受局灶性脉冲和转子标测（FIRM）的AF患者中，29例连续患者（60年8次，79%持续性）复发，也在重复手术时标测（21 +/- 20个月后）使用小心放置的64极篮和RhythmView（TM）（Topera，门洛帕克，加利福尼亚州，美国）识别AF源和紊乱区域。与指数房颤相比，复发性房颤的周期长度更长（177 +/- 21 vs. 167 +/- 19毫秒，P = 0.01）。所有患者（100%）在手术之间有1个或多个保留的AF转子，周围结构紊乱。肺静脉隔离术后复发性房颤的源数量与首次房颤相似（3.2 +/- 1.4 vs. 3.1 +/- 1.0，P = 0.79），但FIRM+肺静脉隔离术后复发性房颤的源数量低于首次房颤（4.4 +/- 1.4 vs. 2.9 +/- 1.7，P = 0.03）。总的来说，81%（61/75）的AF源位于保守区域，而19%（14/75）被检测到的novo.Conclusionelectrical传播模式为复发性AF消融失败后，在个别患者的索引AF相似。这些数据支持的AF基板超过1-2年的时空稳定性。试验应确定在肺静脉隔离基础上增加基质标测和消融治疗复发性房颤的相对受益。
Conserved Rotors in Recurrent AFIntroductionRecurrent atrial fibrillation (AF) after ablation is associated with reconnection of initially isolated pulmonary vein (PV) trigger sites. Substrates are often targeted in addition to PVI, but it is unclear how substrates progress over time. We studied if substrates in recurrent AF are conserved or have developed de novo from pre-ablation AF.Methods and ResultsOf 137 patients undergoing Focal Impulse and Rotor Mapping (FIRM) at their index procedure for AF, 29 consecutive patients (60 8 years, 79% persistent) recurred and were also mapped at repeat procedure (21 +/- 20 months later) using carefully placed 64-pole baskets and RhythmView(TM) (Topera, Menlo Park, CA, USA) to identify AF sources and disorganized zones. Compared to index AF, recurrent AF had a longer cycle length (177 +/- 21 vs. 167 +/- 19 milliseconds, P = 0.01). All patients (100%) had 1 or more conserved AF rotors between procedures with surrounding disorganization. The number of sources was similar for recurrent AF post-PVI versus index AF (3.2 +/- 1.4 vs. 3.1 +/- 1.0, P = 0.79), but was lower for recurrent AF after FIRM+PVI versus index AF (4.4 +/- 1.4 vs. 2.9 +/- 1.7, P = 0.03). Overall, 81% (61/75) of AF sources lay in conserved regions, while 19% (14/75) were detected de novo.ConclusionElectrical propagation patterns for recurrent AF after unsuccessful ablation are similar in individual patients to their index AF. These data support temporospatial stability of AF substrates over 1-2 years. Trials should determine the relative benefit of adding substrate mapping and ablation to PVI for recurrent AF.