Lazar Sorin, Dixit Sanjay, Marchlinski Francis E, Callans David J, Gerstenfeld Edward P
Electrophysiology Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pa, USA.
Circulation. 2004 Nov 16;110(20):3181-6. doi: 10.1161/01.CIR.0000147279.91094.5E. Epub 2004 Nov 8.
Recent studies have demonstrated spatiotemporal organization in atrial fibrillation (AF), with a left-to-right atrial frequency gradient during AF in isolated sheep hearts. We hypothesized that human AF would also manifest a left-to-right atrial frequency gradient.
Thirty-one patients aged 56.7+/-10.5 years with a history of paroxysmal or persistent (>1 month) AF were included. Recordings were made at each pulmonary vein (PV) ostium and simultaneously from the coronary sinus (CS) and posterior right atrium (RA) during AF. Sequential fast Fourier transforms (FFTs) were performed. FFT profiles were analyzed to determine the dominant frequency (DF). There were 18 patients with paroxysmal AF and 13 with persistent AF. In the paroxysmal group, there was a significant left-to-right atrial DF gradient, with DF highest at the PV/left atrial (LA) junction, intermediate at the CS, and lowest in the RA (6.2+/-0.8, 5.5+/-0.7, and 5.1+/-0.6 Hz, respectively; P<0.001). There were no patients in whom DF was greater at the RA than the PV/LA junction. In the persistent group, there was no significant difference between DF recorded from the LA/PV junction, CS, and RA (6.1+/-0.7, 5.8+/-0.6, and 5.8+/-0.6 Hz, respectively; P=NS).
In humans with paroxysmal AF, DFs are highest at the PV/LA junction, intermediate in the CS, and slowest in the posterior RA. These findings agree with animal models that suggest that the posterior LA may play an important role in maintaining paroxysmal AF. The role of the posterior LA in persistent AF requires further study.
近期研究已证实心房颤动（AF）存在时空组织，在离体绵羊心脏的房颤过程中存在从左心房到右心房的频率梯度。我们推测人类房颤也会表现出从左心房到右心房的频率梯度。
纳入31例年龄为56.7±10.5岁、有阵发性或持续性（>1个月）房颤病史的患者。在房颤期间，于每个肺静脉（PV）开口处以及同时从冠状窦（CS）和右心房后壁（RA）进行记录。进行连续快速傅里叶变换（FFT）。分析FFT图谱以确定主导频率（DF）。有18例阵发性房颤患者和13例持续性房颤患者。在阵发性房颤组中，存在显著的从左心房到右心房的DF梯度，DF在PV/左心房（LA）交界处最高，在CS处居中，在RA处最低（分别为6.2±0.8、5.5±0.7和5.1±0.6Hz；P<0.001）。没有患者的RA处DF大于PV/LA交界处。在持续性房颤组中，LA/PV交界处、CS和RA记录的DF之间无显著差异（分别为6.1±0.7、5.8±0.6和5.8±0.6Hz；P=无显著性差异）。
在阵发性房颤患者中，DF在PV/LA交界处最高，在CS处居中，在右心房后壁最慢。这些发现与动物模型一致，提示左心房后壁可能在维持阵发性房颤中起重要作用。左心房后壁在持续性房颤中的作用需要进一步研究。
