Lazar Sorin, Dixit Sanjay, Callans David J, Lin David, Marchlinski Francis E, Gerstenfeld Edward P
Department of Medicine, Electrophysiology Division, University of Pennsylvania Health System, Philadelphia, 19104, USA.
Heart Rhythm. 2006 Aug;3(8):889-95. doi: 10.1016/j.hrthm.2006.04.018. Epub 2006 Apr 22.
We previously demonstrated the existence of a left-to-right atrial dominant frequency gradient during paroxysmal but not persistent atrial fibrillation (AF) in humans. One possible mechanism of the left-to-right dominant frequency gradient involves the role of the pulmonary veins (PVs) in AF maintenance.
The purpose of this study was to examine the effect of PV isolation on the dominant frequency gradient and outcome after PV isolation.
Patients with either paroxysmal or persistent AF were studied. Recordings were made from catheters in the coronary sinus (CS), posterior right atrium (RA), and posterior left atrium (LA) during AF before and after PV isolation. Mean left-to-right dominant frequency gradient was measured before and after segmental PV isolation. Patients were followed for AF recurrence after PV isolation.
Twenty-seven patients with paroxysmal (n = 15) or persistent (n = 12) AF were studied. In the paroxysmal group, baseline dominant frequency was greatest in the posterior LA with a significant left-to-right atrial dominant frequency gradient (posterior LA = 6.2 +/- 0.9 Hz, CS = 5.8 +/- 0.8 Hz, posterior RA = 5.4 +/- 0.9 Hz; P <.001). After PV isolation, there was no regional difference in dominant frequency (5.9 +/- 0.7 Hz vs 5.7 +/- 0.6 Hz vs 5.7 +/- 0.7 Hz, respectively; P = NS). In the persistent AF group, there was no overall difference in dominant frequency among sites before or after PV isolation (P = NS); however, patients with long-term freedom from AF after PV isolation had a higher left-to-right dominant frequency gradient compared with patients with recurrent AF (0.4 vs 0.1 Hz; P <.05).
PV isolation results in a loss in the left-to-right dominant frequency gradient in patients with paroxysmal AF. This finding supports the critical role of PVs in the maintenance of ongoing paroxysmal AF. Patients with persistent AF and a baseline left-to-right dominant frequency gradient have a better success rate with PV isolation alone compared with patients without a dominant frequency gradient.
我们之前证明了在人类阵发性而非持续性心房颤动（AF）期间存在从左到右的心房主导频率梯度。从左到右主导频率梯度的一种可能机制涉及肺静脉（PVs）在房颤维持中的作用。
本研究的目的是检查PV隔离对主导频率梯度的影响以及PV隔离后的结果。
研究阵发性或持续性AF患者。在PV隔离前后的房颤期间，从冠状窦（CS）、右房后壁（RA）和左房后壁（LA）的导管进行记录。在节段性PV隔离前后测量平均从左到右的主导频率梯度。对患者进行PV隔离后的房颤复发随访。
研究了27例阵发性（n = 15）或持续性（n = 12）AF患者。在阵发性组中，基线主导频率在左房后壁最高，存在显著的从左到右的心房主导频率梯度（左房后壁 = 6.2 +/- 0.9 Hz，冠状窦 = 5.8 +/- 0.8 Hz，右房后壁 = 5.4 +/- 0.9 Hz；P <.001）。PV隔离后，主导频率无区域差异（分别为5.9 +/- 0.7 Hz、5.7 +/- 0.6 Hz和5.7 +/- 0.7 Hz；P = 无显著性差异）。在持续性AF组中，PV隔离前后各部位的主导频率无总体差异（P = 无显著性差异）；然而，PV隔离后长期无房颤的患者与房颤复发患者相比，从左到右的主导频率梯度更高（0.4对0.1 Hz；P <.05）。
PV隔离导致阵发性AF患者从左到右的主导频率梯度消失。这一发现支持了PVs在维持持续性阵发性AF中的关键作用。与没有主导频率梯度的患者相比，具有基线从左到右主导频率梯度的持续性AF患者单独进行PV隔离的成功率更高。
