Saksena Sanjeev, Skadsberg Nicholas D, Rao Hygriv B, Filipecki Artur
Electrophysiology Research Foundation, Warren, New Jersey, USA.
J Cardiovasc Electrophysiol. 2005 May;16(5):494-504. doi: 10.1111/j.1540-8167.2005.40531.x.
While atrial fibrillation (AF) initiation in the pulmonary veins has been well-studied, simultaneous biatrial and three-dimensional noncontact mapping (NCM) has not been performed. We hypothesized that these two techniques would provide novel information on triggers, initiation, and evolution of spontaneous AF and permit study of different AF populations.
The origin of atrial premature beats (APBs), onset of spontaneous AF and its evolution were analyzed in 50 patients with AF in the presence or absence of structural heart disease (SHD) and in different AF presentations (group A: Persistent, group B: Paroxysmal). In 45 patients, spontaneous APBs in the right atrium (RA; n = 60) and left atrium (LA; n = 25) with similar regional distributions regardless of heart disease status were demonstrated. In total, 22 patients (44%) had > or =2 disparate regional origins. Biatrial regional foci were seen with equal frequency in patients with SHD (31%), without SHD (40%), in group A (32%), and in group B (36%). Biatrial mapping and NCM showed organized monomorphic atrial tachyarrhythmias arising in the RA (17), septum (17), or LA (21) and were classified as atrial flutter (RA = 34, LA = 8), macro-reentrant atrial tachycardia (RA = 1, LA = 3) or focal atrial tachycardia (RA = 2, LA = 7). Their regional distribution was more extensive in patients with SHD and persistent AF compared with patients without SHD or paroxysmal AF. Simultaneous biatrial tachycardias were observed only in group A patients and those with SHD.
Simultaneous biatrial and NCM permits successful AF mapping in different AF populations and demonstrates a biatrial spectrum of spontaneous triggers and tachycardias. Organized monomorphic tachycardias with multiple unilateral or biatrial locations are commonly observed in human AF. Patients with heart disease or persistent AF have a more extensive distribution as well as simultaneous coexistence of multiple tachycardias during AF.
虽然肺静脉中房颤（AF）的起始已得到充分研究，但尚未进行双心房同步三维非接触标测（NCM）。我们推测这两种技术将提供有关自发房颤的触发因素、起始和演变的新信息，并允许对不同房颤人群进行研究。
分析了50例房颤患者（存在或不存在结构性心脏病（SHD）以及不同房颤表现形式（A组：持续性，B组：阵发性））的房性早搏（APB）起源、自发房颤的发作及其演变。在45例患者中，无论心脏病状态如何，右心房（RA；n = 60）和左心房（LA；n = 25）出现的自发APB具有相似的区域分布。总共有22例患者（44%）有≥2个不同的区域起源。在有SHD的患者（31%）、无SHD的患者（40%）、A组（32%）和B组（36%）中，双心房区域病灶出现的频率相同。双心房标测和NCM显示在RA（17例）、间隔（17例）或LA（21例）出现有组织的单形性房性快速心律失常，并被分类为房扑（RA = 34例，LA = 8例）、大折返性房性心动过速（RA = 1例，LA = 3例）或局灶性房性心动过速（RA = 2例，LA = 7例）。与无SHD或阵发性房颤的患者相比，有SHD和持续性房颤的患者其区域分布更广泛。仅在A组患者和有SHD的患者中观察到双心房同时性心动过速。
双心房同步和NCM允许在不同房颤人群中成功进行房颤标测，并显示出自发触发因素和心动过速的双心房谱。在人类房颤中常见有多个单侧或双心房部位的有组织单形性心动过速。患有心脏病或持续性房颤的患者在房颤期间有更广泛的分布以及多种心动过速同时并存。
