Schricker Amir A, Lalani Gautam G, Krummen David E, Narayan Sanjiv M
Department of Medicine/Cardiology, University of California San Diego Medical Center, San Diego, CA, 92161, USA.
Curr Cardiol Rep. 2014 Aug;16(8):509. doi: 10.1007/s11886-014-0509-0.
Atrial fibrillation (AF) is the most common arrhythmia targeted by catheter ablation. Despite significant advances in our understanding of AF, ablation outcomes remain suboptimal, and this is due in large part to an incomplete understanding of the underlying sustaining mechanisms of AF. Recent developments of patient-tailored and physiology-based computational mapping systems have identified localized electrical spiral waves, or rotors, and focal sources as mechanisms that may represent novel targets for therapy. This report provides an overview of Focal Impulse and Rotor Modulation (FIRM) mapping, which reveals that human AF is often not actually driven by disorganized activity but instead that disorganization is secondary to organized rotors or focal sources. Targeted ablation of such sources alone can eliminate AF and, when added to pulmonary vein isolation, improves long-term outcome compared with conventional ablation alone. Translating mechanistic insights from such patient-tailored mapping is likely to be crucial in achieving the next major advances in personalized medicine for AF.
心房颤动（AF）是导管消融术针对的最常见心律失常。尽管我们对AF的认识有了显著进展，但消融结果仍不尽人意，这在很大程度上是由于对AF潜在维持机制的理解不完整。患者个体化和基于生理学的计算标测系统的最新进展已确定局部电螺旋波或转子以及局灶性起源是可能代表新治疗靶点的机制。本报告概述了局灶性冲动与转子调制（FIRM）标测，该标测揭示人类AF通常并非实际由紊乱活动驱动，而是紊乱继发于有组织的转子或局灶性起源。单独对此类起源进行靶向消融可消除AF，并且与单纯传统消融相比，当联合肺静脉隔离时可改善长期预后。将此类患者个体化标测的机制性见解转化应用可能对实现AF个性化医学的下一个重大进展至关重要。
