Hori Yuichi, Nakahara Shiro, Kamijima Tohru, Tsukada Naofumi, Hayashi Akiko, Kobayashi Sayuki, Sakai Yoshihiko, Taguchi Isao
Department of Cardiology, Dokkyo Medical University Koshigaya Hospital.
Circ J. 2014;78(8):1851-7. doi: 10.1253/circj.cj-14-0440. Epub 2014 Jul 9.
Atrial low-voltage areas are suggested to be related to maintenance of atrial fibrillation (AF). The influence of the left atrium (LA) contact area (CoA) has not been investigated.
Twenty-two persistent AF patients underwent high-density mapping during AF and sinus rhythm (SR). Three representative CoA regions in the LA (ascending aorta: anterior wall; descending aorta: left inferior pulmonary vein [LIPV]; and vertebrae: posterior wall) were identified. Electrogram analysis of both high dominant frequency (high-DF; >8 Hz) and complex fractionated atrial electrogram (con-CFAE; <50 ms) regions during SR was done. The anatomical relationship between CoA and both the very low-voltage areas (vLVA; <0.2 mV) and high-frequency sources was determined. Forty-seven vLVA (194.4 cm(2)) and 60 CoA (337.0 cm(2)) were documented, and 32 vLVA directly overlapped CoA. The vLVA were preferentially found in the anterior (45%) and posterior (13%) walls of the LA, and in the LIPV (13%), and corresponded to CoA sites. The mean voltage during SR at high-DF sites was significantly lower than that at con-CFAE sites (0.62 vs.1.54 mV; P<0.0001). Seventy-two percent of high-DF sites overlapped CoA, while 54% of con-CFAE did. Furthermore, 44% of high-DF surface area directly overlapped CoA, while only 19% of con-CFAE did.
Very low-voltage regions had a strong association with CoA. Sites with CoA had a higher incidence of fractionated electrograms both during SR and AF.
心房低电压区域被认为与房颤（AF）的维持有关。左心房（LA）接触面积（CoA）的影响尚未得到研究。
22例持续性AF患者在房颤和窦性心律（SR）期间接受了高密度标测。确定了LA中的三个代表性CoA区域（升主动脉：前壁；降主动脉：左下肺静脉[LIPV]；椎体：后壁）。对SR期间的高主频（高-DF；>8Hz）和复杂碎裂心房电图（con-CFAE；<50ms）区域进行了电图分析。确定了CoA与极低电压区域（vLVA；<0.2mV）和高频源之间的解剖关系。记录了47个vLVA（194.4cm²）和60个CoA（337.0cm²），32个vLVA直接与CoA重叠。vLVA优先出现在LA的前壁（45%）和后壁（13%）以及LIPV（13%）中，且与CoA部位相对应。SR期间高-DF部位的平均电压显著低于con-CFAE部位（0.62对1.54mV；P<0.0001）。72%的高-DF部位与CoA重叠，而54%的con-CFAE部位重叠。此外，44%的高-DF表面积直接与CoA重叠，而只有19%的con-CFAE表面积重叠。
极低电压区域与CoA密切相关。有CoA的部位在SR和AF期间碎裂电图的发生率更高。
