New Insights Into Understanding Rotor Versus Focal Activation in Patients With Persistent Atrial Fibrillation.
New Insights Into Understanding Rotor Versus Focal Activation in Patients With Persistent Atrial Fibrillation.
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DOI：
10.1016/j.jacep.2020.12.010
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Waldo AL
中科院分区：
文献类型：
--
作者：
Lee S;Khrestian CM;Sahadevan J;Markowitz A;Waldo AL
最近对持续性心房颤动（AF）患者的接触图谱研究表明，相分析产生的机制结果与经典的激活序列分析不同。我们对持续性房颤患者的研究表明，病灶源有时会产生重复性的想要再入，即不完全再入。本研究旨在验证以下假设：1)当使用相位分析时，重复的想要再入产生相位奇点，即转子；2)稳定转子的位置靠近焦源。在心脏直视手术期间，我们使用510-512电极同时记录了12例持续性房颤患者的双心房激活。我们对4秒的映射数据进行了激活序列映射和相位分析。对于每个检测到的稳定转子（> 2个完整旋转[720°]在同一位置重复出现），从激活序列图中检查相应的激活模式。房颤期间，所有患者的双心房均有相位奇异点（转子）。然而，只有6/12的患者出现了稳定的相位奇异点。每位患者的稳定相位奇点范围为0 - 6（共14个）。稳定的相位奇点是由震源或被动激活产生的重复的想要再入产生的。传导阻滞有时会产生稳定的相位奇点（2例）。焦源与稳定转子之间的平均距离为0.9±0.3 cm。重复的期望再入产生稳定的转子附近的焦点源。没有发生真正的再入。最近对持续性心房颤动（AF）患者的研究表明，相分析产生的机制结果与经典的激活序列分析不同。我们的数据表明，通过激活序列分析确定的重复的想要再入产生了相位分析确定的稳定的相位奇点（“转子”）。重要的是，重复的焦点激活可以产生一个重复的想要再入，在焦点激活的位置附近产生一个稳定的相位奇点（“转子”）。这些发现支持这样一种可能性，即在明显转子部位终止AF的靶向消融可能是对驱动AF的焦点源的消融。
Recent contact mapping studies in patients with persistent atrial fibrillation (AF) demonstrated that phase analysis produced a different mechanistic result than classical activation sequence analysis. Our studies in patients with persistent AF showed that focal sources sometimes produced repetitive wannabe reentry, i.e., incomplete reentry. This study was to test the hypotheses that 1) when using phase analysis, repetitive wannabe reentry produces a phase singularity point, i.e., a rotor; 2) the location of the stable rotor is close to the focal source. During open heart surgery, we recorded activation from both atria simultaneously using 510–512 electrodes in 12 patients with persistent AF. We performed activation sequence mapping and phase analyses on 4 seconds of mapped data. For each detected stable rotor (> 2 full rotations [720°] recurring at the same site), the corresponding activation patterns were examined from the activation sequence maps. During AF, phase singularity points (rotors) were identified in both atria in all patients. However, stable phase singularity points were only present in 6/12 patients. The range of stable phase singularity points per patient was 0 – 6 (total 14). Stable phase singularity points were produced due to repetitive wannabe reentry generated from a focal source or by passive activation. A conduction block sometimes created a stable phase singularity point (2 patients). The average distance between a focal source and a stable rotor was 0.9±0.3 cm. Repetitive wannabe reentry generated stable rotors adjacent to a focal source. No true reentry occurred. Recent studies in patients with persistent atrial fibrillation (AF) demonstrated that phase analysis produces a different mechanistic result than classical activation sequence analysis. Our data demonstrated that repetitive wannabe reentry identified by activation sequence analysis produced a stable phase singularity point (“rotor”) identified by phase analysis. Importantly, repetitive focal activation can produce a repetitive wannabe reentry that generates a stable phase singularity point (“rotor”) adjacent to a site of focal activation. These findings support the possibility that targeted ablation that terminates AF at apparent rotor sites may be an ablation of focal sources that drive AF.
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稳定转子或焦点源的直接或巧合消除可能解释了成功的房颤消融：确认试验的对治疗分析（对AF的常规消融有或没有局灶性脉冲脉冲和转子调制）。
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Clopton, Paul;Shivkumar, Kalyanam;Miller, John M.
通讯作者：
Miller, John M.
影响因子：
8.4
作者：
Podziemski, Piotr;Zeemering, Stef;Schotten, Ulrich
通讯作者：
Schotten, Ulrich
DOI：
10.1016/j.jacep.2016.02.009
发表时间：
2016-11-01
期刊：
JACC. Clinical electrophysiology
影响因子：
--
作者：
Gizurarson, Sigfus;Dalvi, Rupin;Chauhan, Vijay S
通讯作者：
Chauhan, Vijay S
DOI：
10.1161/circep.115.002721
发表时间：
2015-06
期刊：
Circulation. Arrhythmia and electrophysiology
影响因子：
--
作者：
Benharash P;Buch E;Frank P;Share M;Tung R;Shivkumar K;Mandapati R
通讯作者：
Mandapati R
DOI：
10.1161/circep.116.004899
发表时间：
2017-05
期刊：
Circulation. Arrhythmia and electrophysiology
影响因子：
--
作者：
Roney CH;Cantwell CD;Bayer JD;Qureshi NA;Lim PB;Tweedy JH;Kanagaratnam P;Peters NS;Vigmond EJ;Ng FS
通讯作者：
Ng FS