Tada Hiroshi, Yoshida Kentaro, Chugh Aman, Boonyapisit Warangkna, Crawford Thomas, Sarrazin Jean-Francois, Kuhne Michael, Chalfoun Nagib, Wells Darryl, Dey Sujoya, Veerareddy Srikar, Billakanty Sree, Wong Wai Shun, Kalra Dinesh, Kfahagi Ayman, Good Eric, Jongnarangsin Krit, Pelosi Frank, Bogun Frank, Morady Fred, Oral Hakan
Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2008 Jun;19(6):606-12. doi: 10.1111/j.1540-8167.2008.01148.x. Epub 2008 Mar 28.
Complex fractionated atrial electrograms (CFAEs) may play a role in the genesis of atrial fibrillation (AF). One type of CFAE is continuous electrical activity (CEA). The prevalence and characteristics of CEA in patients with paroxysmal and persistent AF are unclear.
In 44 patients (age = 59 +/- 8 years) with paroxysmal (25) or persistent (19) AF, bipolar electrograms were systematically recorded for > or =5 seconds at 24 left atrial (LA) sites, including 8 antral sites, and 2 sites within the coronary sinus (CS). CEA was defined as continuous depolarization for >1 second with no isoelectric interval. CEA was recorded at the LA septum (79%), antrum (66%), posterior (68%) and anterior walls (67%), roof (66%), base of the LA appendage (61%), inferior wall (61%), posterior mitral annulus (48%), CS (41%), and in the LA appendage (14%). Antral CEA was equally prevalent in patients with paroxysmal (63%) and persistent AF (70%, P = 0.12). In patients with paroxysmal AF, the prevalence of CEA was similar among antral and nonantral LA sites, except for the LA appendage. However, in patients with persistent AF, CEA was more prevalent at the nonantral (80%) than antral sites (70%, P = 0.03). CEA at nonantral sites except the CS was more prevalent in persistent than in paroxysmal AF (80% vs 57%, P < 0.001). The mean duration of intermittent episodes of CEA was longer in persistent than in paroxysmal AF (P < 0.001).
The higher prevalence and duration of CEA at nonantral sites in persistent than in paroxysmal AF is consistent with a greater contribution of LA reentrant mechanisms in persistent AF. However, the high prevalence of CEA at nonantral sites in paroxysmal atrial fibrillation (PAF) suggests that CEA alone is a nonspecific marker of appropriate target sites for ablation of AF. The characteristics of CEA that most accurately identify drivers of AF remain to be determined.
复杂碎裂心房电图（CFAEs）可能在房颤（AF）的发生机制中起作用。CFAE的一种类型是持续电活动（CEA）。阵发性和持续性房颤患者中CEA的患病率及特征尚不清楚。
对44例年龄为59±8岁的阵发性（25例）或持续性（19例）房颤患者，在24个左心房（LA）部位（包括8个窦部部位以及冠状窦（CS）内的2个部位）系统记录双极电图≥5秒。CEA定义为持续去极化>1秒且无等电位间期。CEA记录于LA间隔（79%）、窦部（66%）、后壁（68%）、前壁（67%）、顶部（66%）、LA心耳基部（61%）、下壁（61%）、二尖瓣后环（48%）、CS（41%）以及LA心耳（14%）。窦部CEA在阵发性房颤患者（63%）和持续性房颤患者（70%，P = 0.12）中的患病率相当。在阵发性房颤患者中，除LA心耳外，窦部和非窦部LA部位CEA的患病率相似。然而，在持续性房颤患者中，非窦部（80%）的CEA患病率高于窦部（70%，P = 0.03）。除CS外，非窦部部位的CEA在持续性房颤中比阵发性房颤更常见（80%对57%，P < 0.001）。持续性房颤中CEA间歇性发作的平均持续时间长于阵发性房颤（P < 0.001）。
持续性房颤中非窦部部位CEA的患病率和持续时间高于阵发性房颤，这与LA折返机制在持续性房颤中起更大作用一致。然而，阵发性房颤（PAF）中非窦部部位CEA的高患病率表明，单独的CEA是房颤消融合适靶点的非特异性标志物。最准确识别房颤驱动因素的CEA特征仍有待确定。
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