Driver Domains in Persistent Atrial Fibrillation
Driver Domains in Persistent Atrial Fibrillation
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DOI：
10.1161/circulationaha.113.005421
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发表时间：
2014-08-12
期刊：
影响因子：
37.8
通讯作者：
Dubois, Remi
中科院分区：
文献类型：
--
作者：
Haissaguerre, Michel;Hocini, Meleze;Dubois, Remi
特定背景的非侵入性信号处理，以确定司机在不同类别的持续性房颤（AF）。方法和结果，在103例连续持续性房颤，准确的双心房几何形状相对于一个阵列的252个身体表面电极从非对比度计算机断层扫描。对在床边从多个窗口（持续时间，9 +/- 1 s）采集的重建单极AF电描记图进行信号处理，以识别驱动因素（局灶性或折返性活动）及其累积密度图。与分步消融对照组相比，通过使用AF终止作为手术终点对驱动域进行导管消融。这些地图显示了不断变化的节拍到节拍的波前和驾驶员活动的不同时空行为。折返没有持续（中位数，2.6次旋转，持续449 +/- 89 ms），基本上是曲折的，但在同一区域重复复发。总共在103例患者中识别出4720个驱动因素：3802例（80.5%）折返和918例（19.5%）局灶性突破;其中大多数是共定位的。其中，69%的折返和71%的病灶位于左心房。单独的驱动器消融分别终止了75%和15%的持续性和持久性AF。靶向驱动区域的数量随着持续性AF的持续时间而增加：窦性心律患者2例，持续1至3个月的AF患者3例，持续4至6个月的AF患者4例，持续更长时间的AF患者6例。6个月后终止率急剧下降。射频消融至房颤终止的平均时间为28 ± 17分钟，对照组为65 ± 33分钟（P
Background-Specific noninvasive signal processing was applied to identify drivers in distinct categories of persistent atrial fibrillation (AF).Methods and Results-In 103 consecutive patients with persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms acquired at bedside from multiple windows (duration, 9 +/- 1 s) were signal processed to identify the drivers (focal or reentrant activity) and their cumulative density map. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. The maps showed incessantly changing beat-to-beat wave fronts and varying spatiotemporal behavior of driver activities. Reentries were not sustained (median, 2.6 rotations lasting 449 +/- 89 ms), meandered substantially but recurred repetitively in the same region. In total, 4720 drivers were identified in 103 patients: 3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs; most of them colocalized. Of these, 69% reentries and 71% foci were in the left atrium. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The number of targeted driver regions increased with the duration of continuous AF: 2 in patients presenting in sinus rhythm, 3 in AF lasting 1 to 3 months, 4 in AF lasting 4 to 6 months, and 6 in AF lasting longer. The termination rate sharply declined after 6 months. The mean radiofrequency delivery to AF termination was 28 +/- 17 minutes versus 65 +/- 33 minutes in the control group (P