Platonov Pyotr G, Sanders Prashanthan, Brooks Anthony, Tapanainen Jari M, Holmqvist Fredrik, Kongstad Ole, Carlson Jonas
Department of Cardiology, Clinical Sciences, Lund University, and Center for Integrative Electrocardiology at Lund University (CIEL), Lund, Sweden.
J Electrocardiol. 2011 Mar-Apr;44(2):157-63. doi: 10.1016/j.jelectrocard.2010.11.004. Epub 2010 Dec 18.
Correlation function analysis applied to endocardial electrograms has earlier been used for analysis of agreement between signals and direction of activation during atrial fibrillation (AF). This study was aimed at evaluating whether preferential activation patterns along the coronary sinus (CS) exist in patients with AF.
Twenty-seven patients (57 ± 10 years old) admitted for electrophysiological (EP) study (10 patients) and/or AF ablation (17 patients) were studied, 8 with permanent and 19 with persistent AF. Unipolar signals were recorded during 60 seconds from a 10-pole CS catheter during AF at baseline (BL) and after isolation of left and right pulmonary veins and after additional lines in the left atrium (LA) (End). Correlation function analysis was applied to signals from each pair of adjacent electrodes, and graphs of cumulated time delay were made to enable interpretation of direction of activation.
Correlation between paired signals was highest in the distal and middle parts of CS and lowest in the proximal CS. In 21 patients, correlation values greater than 0.8 between closely spaced electrodes suggested uniform propagation of the fibrillatory waves. In 18 of 21 patients, preferential conduction pattern along CS was seen. Of those, 15 patients had left-to-right conduction, and 3 had right-to-left conduction. During ablation, atrial fibrillation cycle length increased from 184 ± 32 milliseconds at BL to 193 ± 39 milliseconds after pulmonary vein isolation and 215 ± 39 milliseconds at the end of ablation (P = .03, BL vs End). Because of ablation, preferential conduction along CS changed in 4 patients from left to right at BL to simultaneous CS activation or right to left. In 1 of 3 patients with simultaneous activation at BL, the direction changed to right to left. No direction change was observed in any of the 3 patients with right-to-left activation at BL.
Atrial activation during AF exhibits a high degree of organization in distal and middle CS. Preferential conduction patterns observed in most patients may indicate either relatively dominant stable reentry circuits in the LA or activation spread from a focal source. The changes in preferential conduction during ablation of AF may reflect modification of AF substrate and indicate persistent right atrial sources not affected by ablation in the LA only.
将相关函数分析应用于心内膜电图，此前已用于分析房颤（AF）期间信号与激动方向之间的一致性。本研究旨在评估房颤患者沿冠状窦（CS）是否存在优先激动模式。
对27例因电生理（EP）研究（10例）和/或房颤消融（17例）入院的患者进行研究，其中8例为永久性房颤，19例为持续性房颤。在房颤期间，于基线（BL）、左、右肺静脉隔离后以及左心房（LA）追加线性消融后（End），从10极CS导管记录60秒的单极信号。对每对相邻电极的信号进行相关函数分析，并绘制累积时间延迟图以解读激动方向。
配对信号之间的相关性在CS的远端和中部最高，在CS近端最低。在21例患者中，相邻电极之间相关性值大于0.8表明颤动波呈均匀传播。在21例患者中的18例中，观察到沿CS的优先传导模式。其中，15例患者为从左向右传导，3例为从右向左传导。在消融过程中，房颤周期长度从BL时的184±32毫秒增加到肺静脉隔离后的193±39毫秒以及消融结束时的215±39毫秒（P = 0.03，BL与End相比）。由于消融，4例患者沿CS的优先传导从BL时的从左向右变为同时激动CS或从右向左。在3例BL时同时激动的患者中，有1例方向变为从右向左。在3例BL时从右向左激动的患者中，未观察到方向改变。
房颤期间心房激动在CS远端和中部表现出高度的组织性。大多数患者中观察到的优先传导模式可能表明LA中相对占主导地位的稳定折返环或激动从局灶性起源处传播。房颤消融期间优先传导的变化可能反映房颤基质的改变，并表明仅在LA进行消融时未受影响的持续性右心房起源。
