Schilling R J, Kadish A H, Peters N S, Goldberger J, Davies D W
St. Mary's Hospital and Imperial College School of Medicine, London, UK.
Eur Heart J. 2000 Apr;21(7):550-64. doi: 10.1053/euhj.1999.1851.
Endocardial mapping of atrial fibrillation in humans is limited by its low resolution and by complexities in the arrhythmia and atrial anatomy.
A catheter mounted non-contact multielectrode was deployed in the right atrium of 11 patients with atrial fibrillation and used to reconstruct 3360 electrograms, superimposed onto a computer-simulated model of the endocardium, using inverse solution mathematics. This allows construction of isopotential maps of the right atrium. Patients had either sustained atrial fibrillation (n=3) for >6 months or developed atrial fibrillation during the study (n=8). Spontaneous initiation of atrial fibrillation was recorded in one patient and was demonstrated by the non-contact system to arise from two successive atrial ectopic beats from the site of a roving contact catheter. Reconstruction of electrograms recorded during atrial fibrillation was validated by comparison with contact electrograms with cross-correlation. During established atrial fibrillation, four patients predominantly had a single right atrial wave front, two had two wave fronts and five patients had three to five wave fronts for most of the time. Periods of electrical silence were seen in the right atrium in eight patients, after which, activity emerged from consistent septal sites alone, suggesting a left atrial origin. During intravenous administration of flecainide, atrial fibrillation in two patients terminated spontaneously or following pacing manoeuvres, while in the remaining patient sinus rhythm was restored via atrial tachycardia.
Non-contact mapping of the right atrium has demonstrated modes of initiation and termination of atrial fibrillation, characterized different patterns of right atrial activation in atrial fibrillation and suggests that the left atrium may sustain atrial fibrillation in some patients. Simultaneous mapping of the right and left atrium is required to further elucidate the mechanisms of human atrial fibrillation.
人类心房颤动的心内膜标测受限于其低分辨率以及心律失常和心房解剖结构的复杂性。
将一种安装在导管上的非接触式多电极装置部署于11例心房颤动患者的右心房，利用逆解数学方法重建了3360个心内电图，并叠加到心内膜的计算机模拟模型上。这使得能够构建右心房的等电位图。患者中，3例为持续心房颤动（>6个月），8例在研究期间发生心房颤动。在1例患者中记录到心房颤动的自发起始，非接触系统显示其源于可移动接触导管部位的两次连续心房异位搏动。通过与接触式心内电图进行互相关比较，验证了心房颤动期间记录的心内电图的重建。在持续性心房颤动期间，4例患者主要有单个右心房波阵面，2例有两个波阵面，5例患者大部分时间有三至五个波阵面。8例患者的右心房出现电静止期，之后，活动仅从一致的间隔部位出现，提示起源于左心房。在静脉注射氟卡尼期间，2例患者的心房颤动自发终止或在起搏操作后终止，而其余患者通过房性心动过速恢复窦性心律。
右心房的非接触标测已证明心房颤动的起始和终止模式，其特征为心房颤动时右心房激活的不同模式，并提示在某些患者中左心房可能维持心房颤动。需要同时对右心房和左心房进行标测以进一步阐明人类心房颤动的机制。
