Department of Physiology, Maastricht University, Maastricht, The Netherlands.
J Cardiovasc Electrophysiol. 2012 Sep;23(9):980-7. doi: 10.1111/j.1540-8167.2012.02335.x. Epub 2012 May 3.
Stability of CFAE.
The efficacy of complex fractionated atrial electrograms (CFAE) ablation as additional substrate modification in atrial fibrillation (AF) patients has been shown to be highly variable. Recently, the validity of sequential CFAE mapping has been challenged by concerns regarding temporal stability of CFAE. Existing studies on CFAE stability are small with very different CFAE definitions. Here, we undertook a systematic literature review to address these controversial findings.
A systematic search of the scientific literature was performed through to September 1, 2011. From a total of 162 manuscripts, 7 were identified to contain assessment of the temporal stability of CFAE in human AF. These studies included a total of 96 (80 persistent/16 paroxysmal AF) patients (79% male, mean 58 years old). Varying CFAE mapping techniques or definitions were utilized. CFAE stability averaged 81% between 2 high-density sequential fractionation maps over an average time interval of 19 minutes. However, CFAE stability only averaged at 75% from shorter term continuous recordings (mean 15 comparisons within 75 seconds). Although the variability in CFAE cycle length was small (12-15 ms), coefficients of variation in continuous electrical activity were high (up to 300%). The overall spatial distribution of CFAE was found to be stable. Nevertheless, sequential mapping may not capture all CFAE sites given their dynamic characteristics.
CFAE are temporally variable in keeping with the diverse mechanisms underlying their existence. The dynamic nature of CFAE will continue to pose a challenge for electrophysiologists in search of critical sites requiring ablation to combat AF. (J Cardiovasc Electrophysiol, Vol. 23, pp. 980-987, September 2012).
探讨碎裂心房电位（CFAE）的稳定性。
已有研究表明，复杂碎裂心房电图（CFAE）消融作为心房颤动（AF）患者的附加基质修饰的疗效具有高度变异性。最近，由于对 CFAE 时间稳定性的担忧，连续 CFAE 标测的有效性受到了质疑。关于 CFAE 稳定性的现有研究规模较小，且 CFAE 定义也非常不同。在此，我们进行了一项系统的文献复习，以解决这些有争议的发现。
通过科学文献的系统搜索，截至 2011 年 9 月 1 日共检索到 162 篇文献，其中有 7 篇文献评估了人类 AF 中 CFAE 的时间稳定性。这些研究共纳入 96 例患者（80 例持续性/16 例阵发性 AF；79%为男性，平均年龄 58 岁）。不同的 CFAE 标测技术或定义被用于不同的研究中。在平均 19 分钟的时间间隔内，两次高密度分段标测之间 CFAE 的稳定性平均为 81%。然而，在更短时间的连续记录中，CFAE 的稳定性平均仅为 75%（75 秒内平均进行了 15 次比较）。尽管 CFAE 周期长度的变异性较小（12-15 ms），但连续电活动的变异系数较高（高达 300%）。CFAE 的整体空间分布被发现是稳定的。尽管如此，由于其动态特性，连续标测可能无法捕捉到所有的 CFAE 部位。
CFAE 在时间上是可变的，这与它们存在的多种机制相符。CFAE 的动态特性将继续给寻找需要消融以治疗 AF 的关键部位的电生理学家带来挑战。（J 心血管电生理学杂志，23 卷，第 980-987 页，2012 年 9 月）。
