Chen Jian, Off Morten Kristian, Solheim Eivind, Hoff Per Ivar, Schuster Peter, Ohm Ole-Jørgen
Institute of Medicine and Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S190-3. doi: 10.1111/j.1540-8159.2008.02282.x.
Pulmonary vein (PV) isolation is used for the treatment of atrial fibrillation (AF). Complex fractionated atrial electrogram (CFAE) mapping has been introduced to guide AF ablation. However, the spatial relationship between PV and CFAE is not well defined.
The study included 21 patients (mean age 57 +/- 11 years, 17 men, 14 paroxysmal, two persistent, and five long-standing persistent AF) referred for PV isolation. Electrograms were sampled for 8 seconds at each site during stable AF (13 induced). High-frequency was defined as <80 ms of CFAE value. The distance between CFAE and the nearest PV ostium was measured. The PV ostia and antra were demarcated by fluoroscopy guidance and endocardial reconstruction. Among 82 PV mapped (left common four, superior 17, inferior 17; right superior 21, inferior 21, middle 2), 52.4% and 25.6% of high-frequency CFAE were located on the anterior and posterior walls, respectively, inside the PV or at the ostium. No high-frequency CFAE was observed in two out of 60 and one out of 20 PV anteriorly, versus seven out of 60 and 11 out of 20 PV (P < 0.001) posteriorly, in paroxysmal and persistent AF, respectively. In the PV with high-frequency CFAE, the mean shortest distances to the PV ostia in paroxysmal versus persistent AF were 2.7 +/- 5.1 versus 7.4 +/- 5.4 mm anteriorly (P < 0.01), and 6.5 +/- 6.4 versus 9.4 +/- 8.4 mm posteriorly (ns).
During PV isolation, extending the ablation lesions by up to 10 mm from the PV ostia might cover most high-frequency CFAE around the PV antra. High-frequency CFAE were more often located in the PV ostia in paroxysmal than in persistent AF.
肺静脉隔离用于治疗心房颤动（房颤）。碎裂心房电图（CFAE）标测已被引入以指导房颤消融。然而，肺静脉与CFAE之间的空间关系尚未明确界定。
本研究纳入了21例因肺静脉隔离而转诊的患者（平均年龄57±11岁，男性17例，阵发性房颤14例，持续性房颤2例，长期持续性房颤5例）。在稳定房颤期间（诱发13例），在每个部位采集8秒的电图。高频定义为CFAE值<80毫秒。测量CFAE与最近肺静脉口的距离。通过透视引导和心内膜重建来划定肺静脉口和肺静脉窦。在82条被标测的肺静脉中（左总静脉4条，上肺静脉17条，下肺静脉17条；右上肺静脉21条，右下肺静脉21条，右中肺静脉2条），52.4%和25.6%的高频CFAE分别位于肺静脉内或肺静脉口处的前壁和后壁。在阵发性房颤和持续性房颤中，分别有60条肺静脉中的2条和20条肺静脉中的1条在前壁未观察到高频CFAE，而在60条肺静脉中的7条和20条肺静脉中的11条后壁观察到高频CFAE（P<0.001）。在有高频CFAE的肺静脉中，阵发性房颤与持续性房颤相比，到肺静脉口的平均最短距离在前壁分别为2.7±5.1毫米和7.4±5.4毫米（P<0.01），后壁分别为6.5±6.4毫米和9.4±8.4毫米（无显著性差异）。
在肺静脉隔离期间，从肺静脉口向外扩展消融灶达10毫米可能覆盖肺静脉窦周围的大多数高频CFAE。高频CFAE在阵发性房颤中比在持续性房颤中更常位于肺静脉口处。
