Noninvasive Localization of Maximal Frequency Sites of Atrial Fibrillation by Body Surface Potential Mapping
Noninvasive Localization of Maximal Frequency Sites of Atrial Fibrillation by Body Surface Potential Mapping
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DOI：
10.1161/circep.112.000167
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发表时间：
2013-04-01
影响因子：
8.4
通讯作者：
Berenfeld, Omer
中科院分区：
文献类型：
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作者：
Guillem, Maria S.;Climent, Andreu M.;Berenfeld, Omer
背景-房颤（AF）患者高频源消融是恢复窦性心律的有效疗法。然而，这种策略对于没有显着主频 (DF) 梯度的患者可能无效。本研究的目的是探讨是否可以无创地识别人类 AF 中高频活动的部位，这有助于干预计划和治疗。 方法和结果 - 在 14 名有 AF 病史的患者中，同时记录 67 导联体表记录和来自两个心房（包括最高 DF 部位）的 15 个心内膜电图，这是通过心房范围内的实时频率电解剖图预先确定的。将表面导联的功率谱和最高 DF 部位的体表位置与心内信息进行比较。在躯干特定部位发现的最高 DF 与最近心房中发现的 DF 显着相关（右心房 = 0.96，左心房 = 0.92）以及它们之间的 DF 梯度（= 0.93）。表面功率的空间分布显示频率与功率分布面积之间呈反比关系，这与局部快速源一致，即其他地方有颤动传导的 AF 机制。结论 - AF 期间体表记录的频谱分析允许对心房 DF 的全局分布进行无创表征，并识别频率最高的心房，从而为改进无创个性化诊断和治疗提供了可能性。
Background-Ablation of high-frequency sources in patients with atrial fibrillation (AF) is an effective therapy to restore sinus rhythm. However, this strategy may be ineffective in patients without a significant dominant frequency (DF) gradient. The aim of this study was to investigate whether sites with high-frequency activity in human AF can be identified noninvasively, which should help intervention planning and therapy.Methods and Results-In 14 patients with a history of AF, 67-lead body surface recordings were simultaneously registered with 15 endocardial electrograms from both atria including the highest DF site, which was predetermined by atrial-wide real-time frequency electroanatomical mapping. Power spectra of surface leads and the body surface location of the highest DF site were compared with intracardiac information. Highest DFs found on specific sites of the torso showed a significant correlation with DFs found in the nearest atrium (=0.96 for right atrium and =0.92 for left atrium) and the DF gradient between them (=0.93). The spatial distribution of power on the surface showed an inverse relationship between the frequencies versus the power spread area, consistent with localized fast sources as the AF mechanism with fibrillatory conduction elsewhere.Conclusions-Spectral analysis of body surface recordings during AF allows a noninvasive characterization of the global distribution of the atrial DFs and the identification of the atrium with the highest frequency, opening the possibility for improved noninvasive personalized diagnosis and treatment.