Department of Cardiology, Clinical Sciences, Lund University, Lund 22185, Sweden Center for Integrative Electrocardiology at Lund University (CIEL), Lund 22185, Sweden
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy.
Europace. 2014 Nov;16 Suppl 4:iv110-iv119. doi: 10.1093/europace/euu249.
Shortening of atrial refractory period during atrial fibrillation has been considered a hallmark of atrial electrical remodelling. The atrial fibrillatory cycle length, which is intimately related to the atrial fibrillatory rate (AFR), is generally accepted as a surrogate marker for local refractoriness. The value of using AFR to monitor the progress of atrial ablation therapy has been demonstrated and gradual slowing of AFR has consistently been observed to precede arrhythmia termination during paroxysmal or permanent atrial fibrillation ablation. Today, AFR is the key characteristic of the fibrillatory process, repeatedly validated against intracardiac recordings and extensively studied in clinical contexts. This paper provides an overview of clinical data accumulated since the method was introduced in 1998, and to present the current state of knowledge regarding ECG-derived AFR: its time course and dynamics, clinical factors affecting AFR, and available evidence of its value in the clinical context. We conclude that AFR is a promising, easily available AF characteristic that can be derived from the conventional surface ECG. It is clearly a useful tool for monitoring drug effects. Reference values for predicting intervention effect, however, are likely to be population- and context-specific and related to age, clinical types of atrial fibrillation, as well as to presence and advancement of underlying structural heart disease. Prospective studies in homogeneous patient populations are still needed to establish the clinical value of AFR.
心房颤动期间心房不应期缩短被认为是心房电重构的标志。与心房颤动率（AFR）密切相关的心房颤动周期长度通常被认为是局部不应期的替代标志物。已经证明使用 AFR 来监测心房消融治疗进展的价值，并且在阵发性或永久性心房颤动消融期间，AFR 的逐渐减慢一直被观察到先于心律失常终止。如今，AFR 是纤维性过程的关键特征，已经根据心内记录进行了反复验证，并在临床环境中进行了广泛研究。本文综述了自 1998 年该方法引入以来积累的临床数据，并介绍了 ECG 衍生的 AFR 的当前知识状态：其时间过程和动力学、影响 AFR 的临床因素以及其在临床环境中的价值的现有证据。我们得出结论，AFR 是一种很有前途、易于获取的 AF 特征，可以从常规体表心电图中获得。它显然是监测药物效果的有用工具。然而，预测干预效果的参考值可能是特定于人群和特定于背景的，与年龄、心房颤动的临床类型以及潜在结构性心脏病的存在和进展有关。仍需要在同质患者人群中进行前瞻性研究，以确定 AFR 的临床价值。
