Hsu Nei-Wei, Lin Yenn-Jiang, Tai Ching-Tai, Kao Tsair, Chang Shih-Lin, Wongcharoen Wanwarang, Lo Li-Wei, Udyavar Ameya R, Hu Yu-Feng, Tso Han-Wen, Chen Yi-Jen, Higa Satoshi, Chen Shih-Ann
Department of Medicine, Taiwan I-Lan Hospital, I-Lan, Taiwan, Republic of China.
Europace. 2008 Apr;10(4):438-43. doi: 10.1093/europace/eun045. Epub 2008 Mar 3.
Fibrillatory waves observed in the surface electrograms may be a direct reflection of the electrophysiologic mechanism of the atrial fibrillation (AF). This study compared the fibrillatory waves in the surface ECG and the individual intracardiac mapping sites in different types of paroxysmal AF.
Thirty patients with paroxysmal AF originating from the pulmonary veins (PVs) or superior vena cava (SVC) were enrolled. Frequency analysis was performed on the intracardiac electrograms recorded from various mapping sites in both atria sequentially with simultaneous surface electrogram recordings. The SVC-AF patients had a trend toward a higher DF in ECG lead V1 when compared with the PV-AF patients (7.35 +/- 2.09 vs. 5.89 +/- 0.79 Hz, P = 0.018). The mean dominant frequency (DF) of the LA mapping sites in the PV-AF patients was higher than that in the SVC-AF patients (7.06 +/- 0.66 vs. 6.13 +/- 0.96 Hz, P = 0.009), whereas the mean DF of the RA mapping sites was similar between the two groups (5.84 +/- 0.80 vs. 6.26 +/- 1.11 Hz, P = NS). The intra-class correlation coefficient (ICC) between the mean DF of the RA sites and V1 was higher (r = 0.21, P = 0.02) when compared with the mean DF of the LA sites (r = -0.007, P > 0.05). Furthermore, the maximal ICC was observed in the anterolateral RA free wall (r = 0.84, P < 0.001) and not the other anatomic sites of the RA and LA.
The fibrillatory activity observed in ECG lead V1 correlated primarily with the activity of the anterolateral RA free wall and thus may be useful for detecting the AF source if it is close to that area.
体表心电图记录中观察到的颤动波可能是心房颤动（AF）电生理机制的直接反映。本研究比较了不同类型阵发性AF患者体表心电图和各个心内标测部位的颤动波。
纳入30例起源于肺静脉（PVs）或上腔静脉（SVC）的阵发性AF患者。在连续记录双心房各个标测部位的心内电图时同步记录体表心电图，并对其进行频率分析。与PV-AF患者相比，SVC-AF患者在心电图V1导联的主导频率（DF）有升高趋势（7.35±2.09 vs. 5.89±0.79Hz，P = 0.018）。PV-AF患者左心房标测部位的平均主导频率高于SVC-AF患者（7.06±0.66 vs. 6.13±0.96Hz，P = 0.009），而两组右心房标测部位的平均DF相似（5.84±0.80 vs. 6.26±1.11Hz，P = 无统计学意义）。右心房部位平均DF与V1之间的组内相关系数（ICC）高于左心房部位平均DF（r = 0.21，P = 0.02 vs. r = -0.007，P>0.05）。此外，最大ICC出现在右心房前外侧游离壁（r = 0.84，P < 0.001），而非右心房和左心房的其他解剖部位。
心电图V1导联观察到的颤动活动主要与右心房前外侧游离壁的活动相关，因此如果AF起源靠近该区域，可能有助于检测AF起源部位。
