Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Heart Rhythm. 2013 Sep;10(9):1303-10. doi: 10.1016/j.hrthm.2013.06.007. Epub 2013 Jun 14.
Successful termination of atrial fibrillation (AF) during catheter ablation (CA) is associated with arrhythmia-free follow-up. Preablation factors such as mean atrial fibrillation cycle length (AFCL) predict the likelihood of AF termination during ablation but recurring patterns and AFCL stability have not been evaluated.
To investigate novel predictors of acute and postoperative ablation outcomes from intracardiac electrograms: (1) recurring AFCL patterns and (2) localization index (LI) of the instantaneous fibrillatory rate distribution.
Sixty-two patients with AF (32 paroxysmal AF; 45 men; age 57 ± 10 years) referred for CA were enrolled. One-minute electrogram was recorded from coronary sinus (CS; 5 bipoles) and right atrial appendage (HRA; 2 bipoles). Atrial activations were detected automatically to derive the AFCL and instantaneous fibrillatory rate (inverse of AFCL) time series. Recurring AFCL patterns were quantified by using recurrence plot indices (RPIs): percentage determinism, entropy of determinism, and maximum diagonal length. AFCL stability was determined by using the LI. The CA outcome predictivity of individual indices was assessed.
Patients with terminated atrial fibrillation (T-AF) had higher RPI (P < .05 in CS7-8) and LI than did those with nonterminated atrial fibrillation (P < .005 in CS3-4; P < .05 in CS5-6, CS7-8, and HRA). Patients free of arrhythmia after 3-month follow-up had higher RPI and LI (all P < .05 in CS7-8). All indices except percentage determinism predicted T-AF in CS7-8 (area under the curve [AUC] ≥ 0.71; odds ratio [OR] ≥ 4.50; P < .05). The median AFCL and LI predicted T-AF in HRAD (AUC ≥ 0.75; OR ≥ 7.76; P < .05). The RPI and LI predicted 3-month follow-up in CS7-8 (AUC ≥ 0.68; OR ≥ 4.17; P < .05).
AFCL recurrence and stability indices could be used in selecting patients more likely to benefit from CA.
导管消融（CA）过程中心律失常的终止与随访期无心律失常相关。消融前的平均房颤周期长度（AFCL）等因素可预测消融过程中房颤的终止可能性，但尚无研究评估复发模式和 AFCL 的稳定性。
从心内电图中探究急性和术后消融结果的新预测因素：（1）复发的 AFCL 模式和（2）瞬时纤颤率分布的定位指数（LI）。
入选 62 例因房颤（32 例阵发性房颤；45 例男性；年龄 57 ± 10 岁）而接受 CA 的患者。从冠状窦（CS；5 个双极）和右心耳（HRA；2 个双极）记录 1 分钟的电图。自动检测心房激动以获得 AFCL 和瞬时纤颤率（AFCL 的倒数）时间序列。通过使用递归图指数（RPI）量化复发的 AFCL 模式：确定性百分比、确定性熵和最大对角线长度。通过使用 LI 确定 AFCL 的稳定性。评估各个指数对 CA 结果的预测能力。
与非终止性房颤（在 CS3-4 中 P <.005；在 CS5-6、CS7-8 和 HRA 中 P <.05）相比，终止性房颤（T-AF）患者的 RPI（在 CS7-8 中 P <.05）和 LI 更高。在 3 个月随访时无心律失常的患者 RPI 和 LI 更高（在 CS7-8 中均 P <.05）。除了确定性百分比外，所有指数均预测 CS7-8 中的 T-AF（曲线下面积 [AUC]≥0.71；优势比 [OR]≥4.50；P <.05）。中位 AFCL 和 LI 预测 HRAD 中的 T-AF（AUC≥0.75；OR≥7.76；P <.05）。RPI 和 LI 预测 CS7-8 中的 3 个月随访（AUC≥0.68；OR≥4.17；P <.05）。
AFCL 复发和稳定性指数可用于选择更可能从 CA 中获益的患者。
