Takahashi Yoshihide, O'Neill Mark D, Hocini Mélèze, Dubois Rémi, Matsuo Seiichiro, Knecht Sébastien, Mahapatra Srijoy, Lim Kang-Teng, Jaïs Pierre, Jonsson Anders, Sacher Frédéric, Sanders Prashanthan, Rostock Thomas, Bordachar Pierre, Clémenty Jacques, Klein George J, Haïssaguerre Michel
Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux 2, Bordeaux, France.
J Am Coll Cardiol. 2008 Mar 11;51(10):1003-10. doi: 10.1016/j.jacc.2007.10.056.
This study sought to determine the characteristics of atrial electrograms predictive of slowing or termination of atrial fibrillation (AF) during ablation of chronic AF.
There is growing recognition of a role for electrogram-based ablation.
Forty consecutive patients (34 male, 59 +/- 10 years) undergoing ablation for chronic AF persisting for a median of 12 months (range 1 to 84 months) were included. After pulmonary vein isolation and roof line ablation, electrogram-based ablation was performed in the left atrium and coronary sinus. Targeted electrograms were acquired in a 4-s window and characterized by: 1) percentage of continuous electrical activity; 2) bipolar voltage; 3) dominant frequency; 4) fractionation index; 5) mean absolute value of derivatives of electrograms; 6) local cycle length; and 7) presence of a temporal gradient of activation. Electrogram characteristics at favorable ablation regions, defined as those associated with slowing (a >or=6-ms increase in AF cycle length) or termination of AF were compared with those at unfavorable regions.
The AF was terminated by electrogram-based ablation in 29 patients (73%) after targeting a total of 171 regions. Ablation at 37 (22%) of these regions was followed by AF slowing, and at 29 (17%) by AF termination. The percentage of continuous electrical activity and the presence of a temporal gradient of activation were independent predictors of favorable ablation regions (p = 0.016 and p = 0.038, respectively). Other electrogram characteristics at favorable ablation regions were not significantly different from those at unfavorable ablation regions.
Catheter ablation at sites displaying a greater percentage of continuous activity or a temporal activation gradient is associated with slowing or termination of chronic AF.
本研究旨在确定在慢性房颤消融过程中，预测房颤（AF）减慢或终止的心房电图特征。
基于电图的消融作用日益受到认可。
纳入40例连续接受慢性房颤消融治疗的患者（男性34例，年龄59±10岁），慢性房颤持续时间中位数为12个月（范围1至84个月）。在肺静脉隔离和房顶线消融后，于左心房和冠状窦进行基于电图的消融。在4秒窗口内采集目标电图，并通过以下指标进行特征分析：1）连续电活动百分比；2）双极电压；3）主导频率；4）碎裂指数；5）电图导数的平均绝对值；6）局部周期长度；7）激动时间梯度的存在情况。将与房颤减慢（房颤周期长度增加≥6毫秒）或终止相关的有利消融区域的电图特征与不利区域的进行比较。
在总共171个区域进行靶向消融后，29例患者（73%）的房颤通过基于电图的消融终止。其中37个（22%）区域消融后房颤减慢，29个（17%）区域消融后房颤终止。连续电活动百分比和激动时间梯度的存在是有利消融区域的独立预测因素（分别为p = 0.016和p = 0.038）。有利消融区域的其他电图特征与不利消融区域的无显著差异。
在显示连续活动百分比更高或存在激动时间梯度的部位进行导管消融，与慢性房颤的减慢或终止相关。
