Fiala Martin, Wichterle Dan, Chovancík Jan, Bulková Veronika, Wojnarová Dorota, Nevralová Renáta, Januska Jaroslav
Department of Cardiology, Heart Centre, Hospital Podlesí a.s., Trinec, Czech Republic.
Pacing Clin Electrophysiol. 2010 May;33(5):541-8. doi: 10.1111/j.1540-8159.2009.02646.x. Epub 2009 Dec 18.
Left atrial (LA) endocardial voltage characteristics assessed during atrial fibrillation (AF) have not been previously compared in different AF types. This study was aimed at investigating the LA voltages and volumes in patients with paroxysmal and persistent AF.
LA electroanatomic voltage maps acquired during AF were compared between consecutive patients without major structural heart disease undergoing first catheter ablation for paroxysmal AF (n = 100) or persistent AF (n = 100). The groups were comparable in baseline clinical characteristics.
Patients with persistent AF presented with lower median LA voltage (median 0.41, interquartile range [IQR] 0.31-0.51 mV versus median 0.99, IQR 0.47-1.56 mV; P < 0.001), and maximum LA voltage (4.07 +/- 1.76 vs 6.42 +/- 2.16 mV; P < 0.001). They also had a higher proportion of the LA points exhibiting voltage <0.2 mV (30 +/- 20 vs 12 +/- 11%; P < 0.001) and voltage 0.2-1.0 mV (55 +/- 15 vs 42 +/- 19%; P < 0.001). They further displayed higher LA volume/body surface area (75 +/- 16 vs 58 +/- 13 mL/m(2); P < 0.001). In the multivariate regression model, both LA voltage (P < 10(-9)) and LA volume (P < 10(-5)) were significant determinants of AF type.
Patients with persistent AF had significantly lower LA voltage compared with patients with paroxysmal AF even after adjustment for differences in indexed LA volume. LA voltage represents an independent covariate of clinical manifestation of AF.
此前尚未对不同类型心房颤动（AF）期间评估的左心房（LA）心内膜电压特征进行比较。本研究旨在调查阵发性和持续性AF患者的LA电压和容积。
比较了连续的无严重结构性心脏病且首次接受导管消融治疗阵发性AF（n = 100）或持续性AF（n = 100）患者在AF期间获取的LA电解剖电压图。两组在基线临床特征方面具有可比性。
持续性AF患者的LA中位电压较低（中位数0.41，四分位间距[IQR] 0.31 - 0.51 mV，而阵发性AF患者中位数为0.99，IQR 0.47 - 1.56 mV；P < 0.001），LA最大电压也较低（4.07 ± 1.76 vs 6.42 ± 2.16 mV；P < 0.001）。他们的LA电压<0.2 mV的点的比例也更高（30 ± 20 vs 12 ± 11%；P < 0.001）以及电压在0.2 - 1.0 mV的点的比例更高（55 ± 15 vs 42 ± 19%；P < 0.001）。他们还表现出更高的LA容积/体表面积（75 ± 16 vs 58 ± 13 mL/m²；P < 0.001）。在多变量回归模型中，LA电压（P < 10⁻⁹）和LA容积（P < 10⁻⁵）都是AF类型的重要决定因素。
即使在调整了LA容积指数差异后，持续性AF患者的LA电压仍显著低于阵发性AF患者。LA电压是AF临床表现的一个独立协变量。
