Studies of Atrial Fibrillation in Patients

描述（由申请人提供）：这项拟议研究的两个广泛的长期目标是使用电生理技术来提高我们对心房颤动（AF）患者机制的理解，并为其治疗提供改进的基础。本研究计划的具体目的是研究1)心内直视手术期间的患者a)绘制同时在两个心房中激活的序列i)各种类型（阵发性，持续性或永久性）和持续时间（最近发作，数周，数月或数年）的自发性房颤；ii)在AF期间，从一个或多个接近或在周期长度非常短的规律节律区域内的位点进行超速起搏或程序性心房刺激；iii)房颤转复后转为窦性心律；iv)有或无房颤史的患者在窦性心律期间选定心房起搏期间；b) AF期间，识别和表征非常规则但周期长度非常短的区域，被认为是驱动心房产生纤颤传导的区域；c)从不同形式和持续时间的房颤患者的双心房选定部位来表征窦性心律时心房有效不应期，并与无房颤史的正常心房患者进行比较；d)获得术中激活映射期间记录的心房电图的快速傅立叶变换（FFT）分析，以识别并帮助表征具有极短周期长度的规则节律的区域的存在；2)术后使用临时心房心外膜导线电极对新发房颤患者进行心房电图记录，并对心房电图进行FFT分析，以确定并帮助表征周期长度极短的规律心律的存在；b)从显示出非常短周期长度的规律节奏的区域进行超速起搏，以试图终止AF。

DESCRIPTION (provided by applicant): The two broad, long term objectives of this proposed research are to use electrophysiological techniques to improve our understanding of the mechanisms responsible for atrial fibrillation (AF) in patients and to develop an improved basis for its treatment. The specific aims of this research plan are to study patients 1) during open heart surgery a) to map the sequence of atrial activation simultaneously in both atria i) during spontaneous AF of various types (paroxysmal, persistent, or permanent) and duration (recent onset, weeks, months, or years); ii) during overdrive pacing or programmed atrial stimulation during AF from a site or sites close to or within an area of regular rhythm of very short cycle length; iii) following cardioversion of AF to sinus rhythm; iv) during atrial pacing from selected atrial sites during sinus rhythm in patients with or without a history of AF; b) during AF, to identify and characterize areas of very regular but very short cycle length, thought to drive the atria creating fibrillatory conduction; c) to characterize the atrial effective refractory period during sinus rhythm from selected sites in both atria in patients with various forms and durations of AF, and compare that with patients with normal atria and no history of AF; and d) to obtain Fast Fourier Transform (FFT) analysis of atrial electrograms recorded during intraoperative activation mapping to identify and help characterize the presence of a region with a regular rhythm of very short cycle length; and 2) in the postoperative period to use temporary atrial epicardial wire electrodes in patients with new onset AF a) to record atrial electrograms and obtain FFT analysis of these atrial electrograms to identify and help characterize the presence of a regular rhythm of very short cycle length; and b) to perform overdrive pacing from an area demonstrating a regular rhythm of very short cycle length to try to terminate the AF.