Classifying fractionated electrograms in human atrial fibrillation using monophasic action potentials and activation mapping: evidence for localized drivers, rate acceleration, and nonlocal signal etiologies.
Classifying fractionated electrograms in human atrial fibrillation using monophasic action potentials and activation mapping: evidence for localized drivers, rate acceleration, and nonlocal signal etiologies.
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DOI：
10.1016/j.hrthm.2010.10.020
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发表时间：
2011-02
期刊：
影响因子：
5.5
通讯作者：
Hocini M
中科院分区：
文献类型：
--
作者：
Narayan SM;Wright M;Derval N;Jadidi A;Forclaz A;Nault I;Miyazaki S;Sacher F;Bordachar P;Clémenty J;Jaïs P;Haïssaguerre M;Hocini M
房颤（AF）基质标测期间检测到的复杂碎裂电图（CFAE）反映了难以分离的病因。在不了解局部不应性和激活顺序的情况下，CFAE可能代表快速局部活动、无序波碰撞或远场电描记图。本研究的目的是分离人类AF中的CFAE类型，使用单相动作电位（MAP）标测AF中的局部不应性，并使用多极导管标测激动序列。对18例患者（年龄57 ± 13岁，左房直径45 ± 8 mm）在房颤消融前的124个双房部位的MAP和相邻激动序列进行了研究。测量AF周期长度、双极电压和频谱主频以表征CFAE的类型。在91个部位观察到CFAE，其中大多数显示离散MAP和（1）全收缩局部活动（8%）;（2）AF加速后的CFAE，通常伴有MAP交替（8%）;或（3）非局部（远场）信号（67%）。第四种CFAE模式缺乏离散的MAP（17%），与空间无序一致。离散MAP和全收缩期激动（与快速局部AF部位一致）的CFAE比其他CFAE部位具有更短的周期长度（P <0.05）和更低的电压（P <0.05），并倾向于具有更高的主频。许多CFAE，特别是在隔膜和冠状窦，代表远场信号。人类AF中的CFAE代表不同的功能类型，可以使用MAP和激活序列进行分离。在少数情况下，CFAE指示局部快速AF部位。大多数CFAE反映远场信号、AF加速或紊乱。这些结果可能有助于解释AF基质标测过程中的CFAE。
Complex fractionated electrograms (CFAEs) detected during substrate mapping for atrial fibrillation (AF) reflect etiologies that are difficult to separate. Without knowledge of local refractoriness and activation sequence, CFAEs may represent rapid localized activity, disorganized wave collisions, or far-field electrograms. The purpose of this study was to separate CFAE types in human AF, using monophasic action potentials (MAPs) to map local refractoriness in AF and multipolar catheters to map activation sequence. MAP and adjacent activation sequences at 124 biatrial sites were studied in 18 patients prior to AF ablation (age 57 ± 13 years, left atrial diameter 45 ± 8 mm). AF cycle length, bipolar voltage, and spectral dominant frequency were measured to characterize types of CFAE. CFAE were observed at 91 sites, most of which showed discrete MAPs and (1) pansystolic local activity (8%); (2) CFAE after AF acceleration, often with MAP alternans (8%); or (3) nonlocal (far-field) signals (67%). A fourth CFAE pattern lacked discrete MAPs (17%), consistent with spatial disorganization. CFAE with discrete MAPs and pansystolic activation (consistent with rapid localized AF sites) had shorter cycle length (P <.05) and lower voltage (P <.05) and trended to have higher dominant frequency than other CFAE sites. Many CFAEs, particularly at the septa and coronary sinus, represented far-field signals. CFAEs in human AF represent distinct functional types that may be separated using MAPs and activation sequence. In a minority of cases, CFAEs indicate localized rapid AF sites. The majority of CFAEs reflect far-field signals, AF acceleration, or disorganization. These results may help to interpret CFAE during AF substrate mapping.
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影响因子：
24
作者：
Hoppe, BL;Kahn, AM;Narayan, SM
通讯作者：
Narayan, SM
影响因子：
6.1
作者：
Narayan, Sanjiv M.;Franz, Michael R.
通讯作者：
Franz, Michael R.
DOI：
10.1016/s0735-1097(02)01760-6
发表时间：
2002-04-17
影响因子：
24
作者：
Kim, BS;Kim, YH;Ro, YM
通讯作者：
Ro, YM
DOI：
10.1152/ajpheart.1998.275.5.h1635
发表时间：
1998-11-01
影响因子：
4.8
作者：
Koller, ML;Riccio, ML;Gilmour, RF
通讯作者：
Gilmour, RF
影响因子：
24
作者：
Oral, Hakan;Chugh, Aman;Morady, Fred
通讯作者：
Morady, Fred