Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2011 Aug;22(8):851-7. doi: 10.1111/j.1540-8167.2011.02022.x. Epub 2011 Feb 18.
Complex fractionated atrial electrograms (CFAE) have been considered to be helpful during catheter ablation of atrial fibrillation (AF). The purpose of this study was to analyze the characteristics of CFAEs recorded during sinus rhythm (SR) and AF, and to determine their relationship to perpetuation of AF and clinical outcome.
Antral pulmonary vein isolation (APVI) was performed in 34 consecutive patients (age = 59 ± 10 years) with paroxysmal AF who presented in SR. Time- and frequency-domain characteristics of electrograms recorded from the same sites in the coronary sinus (CS) were analyzed during SR and AF, before and during isoproterenol infusion. There was a modest correlation in fractionation index (FI: change in the direction of depolarization, r = 0.40, P = 0.001) and complexity index (CI: change in the polarity of depolarization, r = 0.41, P = 0.001), but not in the dominant frequency (DF) between SR and AF. There was no relationship between the DF and CI or FI during AF. Isoproterenol was associated with an increase in DF during AF (6.6 ± 0.9 vs 5.1 ± 0.6 Hz, P < 0.001) but had no effect on CI or FI (P = 0.6). A higher CI (58.3 ± 21.0/s vs 38.0 ± 21.0/s, P < 0.01), and FI (123.5 ± 44.8/s vs 75.6 ± 44.6/s, P < 0.01) during AF were associated with a lower likelihood of termination of AF during APVI and a higher probability of recurrent AF after ablation. Ratio of FI during AF to SR was also higher when AF persisted than terminated after APVI (29.7 ± 12.4 vs 19.1 ± 9.7, P = 0.002). However, time- or frequency-domain parameters during SR were not predictive of termination or clinical outcome.
Structural and functional properties of the atrial myocardium during AF contribute to electrogram complexity, which may indicate the presence of extra-PV mechanisms of AF that are not eliminated by APVI. Mapping of complex electrograms in SR is not likely to be sufficient to identify drivers of AF.
复杂碎裂心房电图（CFAE）在心房颤动（AF）导管消融中被认为是有帮助的。本研究的目的是分析窦性心律（SR）和 AF 期间记录的 CFAE 的特征，并确定其与 AF 持续存在和临床结果的关系。
对 34 例阵发性 AF 患者（年龄=59±10 岁）在 SR 期间进行了肺静脉前庭隔离（APVI）。在 SR 和 AF 期间，在异丙肾上腺素输注前后，分析了从冠状窦（CS）相同部位记录的电描记图的时频域特征。在分裂指数（FI：去极化方向的变化，r=0.40，P=0.001）和复杂度指数（CI：去极化极性的变化，r=0.41，P=0.001）方面，SR 和 AF 之间存在适度的相关性，但在主导频率（DF）方面没有相关性。在 AF 期间，DF 与 CI 或 FI 之间没有关系。异丙肾上腺素与 AF 期间 DF 的增加有关（6.6±0.9 比 5.1±0.6 Hz，P<0.001），但对 CI 或 FI 没有影响（P=0.6）。AF 时较高的 CI（58.3±21.0/s 比 38.0±21.0/s，P<0.01）和 FI（123.5±44.8/s 比 75.6±44.6/s，P<0.01）与 APVI 期间 AF 终止的可能性较低以及消融后 AF 复发的可能性较高相关。AF 持续时与 SR 相比，AF 时 FI 的比值也更高（29.7±12.4 比 19.1±9.7，P=0.002）。然而，SR 期间的时频域参数不能预测终止或临床结果。
AF 期间心房心肌的结构和功能特性导致电描记图的复杂性，这可能表明存在未被 APVI 消除的 AF 以外的 PV 机制。在 SR 中对复杂电描记图进行映射不太可能足以确定 AF 的驱动因素。
