Determining strength and temporal stability of rotational and focal sources during human atrial fibrillation

项目摘要 心房颤动(房颤)是最常见的心律失常，在此期间正常的有组织的节律 被不规则波传播扰乱并取而代之，这损害了主要的机械功能 心之所向。这是一个严重的健康问题，如果不治疗，可能会导致发病率增加，甚至 死亡率。随着人口老龄化，这是一个日益严重的问题，影响着数百万美国人和 代表着相当大的经济负担。不幸的是，现有的疗法收效甚微， 主要是因为引发和维持房颤的机制仍然知之甚少。 可以在许多离散位置记录单极电信号的多电极阵列被越来越多地使用 确定房颤期间的时空激活模式，并揭示多个 旋转激活源和焦点激活源。以这些源为靶点进行局部消融会导致急性 大约30%-35%的患者会终止房颤，但会导致房颤的长期自由度远远高于 其他疗法(75-80%)。目前尚不清楚为什么一些患者不能迅速终止生命，原因是什么？ 驱动房颤，以及应该首先瞄准哪个震源。 我们建议发展一个定量分析的时间稳定性和强度的旋转和 焦点来源。我们将使用现有的和广泛的单极记录数据集，使用杆 篮形电极，覆盖了中庭的大部分。我们将考虑两组患者：一组 在旋转或局灶性活动部位的靶向消融终止了房颤，在一个没有结束的部位。我们会 使用基于先前发表的研究的方法构建阶段图，并将制定 可以量化震源强度和时间稳定性的算法。比较两种方法的区别 两个小组将使我们能够确定消除污染源是否具有更大的力度或稳定性 可以预测靶向消融的结果。然后，我们的发现将在验证队列中进行测试。我们的研究 应导致改进有针对性的消融战略，促进和促进更好的发展 房颤的治疗策略。

Project Summary Atrial Fibrillation (AF) is the most common cardiac arrhythmia during which the normal, organized rhythm is disrupted and replaced by irregular wave propagation which compromises the primary mechanical function of the heart. It is a serious health concern that, if left untreated, can lead to increased morbidity and even mortality. With the aging of the population, it is a growing problem that affects millions of Americans and represents a considerable economic burden. Unfortunately, the existing therapies have limited success, mostly because the mechanisms that initiate and maintain AF remain poorly understood. Multi-electrode arrays, which can record unipolar electrograms at many discrete sites, are increasingly used to determine the spatio-temporal activation patterns during AF and have revealed the presence of multiple rotational and focal sources of activation. Targeting these sources with localized ablation results in acute termination in roughly 30-35% of patients but can result in long-term freedom of AF that is much higher than other therapies (75-80%). It is currently not clear why some patients do not terminate acutely, which source drives AF, and which source should be targeted first. We propose to develop a quantitative analysis of the temporal stability and the strength of the rotational and focal sources. We will use an existing and extensive data set of unipolar recordings that used a 64-pole basket electrode that covered most of the atrium. We will consider two groups of patients: one in which targeted ablation at sites of rotational or focal activity terminated AF and one in which it did not. We will construct phase maps using a methodology based on a previously published study and will develop algorithms that can quantify the strength and temporal stability of the sources. A comparison between the two groups will allow us to determine whether the elimination of sources with greater strength or stability can predict the result of targeted ablation. Our findings will then be tested in a validation cohort. Our study should result in improved targeted ablation strategies, enabling and advancing the development of better therapeutic strategies for AF.