Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, Hamburg 20099, Germany
Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, Hamburg 20099, Germany.
Europace. 2015 Dec;17(12):1791-7. doi: 10.1093/europace/euv282. Epub 2015 Oct 28.
Ablation of fractionated electrograms (EGMs) has been performed to eliminate areas of slow conduction in atrial fibrillation (AF). The rotor hypothesis suggests that rapidly activating spiral waves perpetuate and maintain AF. This study describes the EGM characteristics of AF rotors, using the novel 64-electrode basket catheter.
Twenty-five patients (male n = 16) with AF (paroxysmal n = 10) underwent focal impulse and rotor modulation. A 3.5 mm irrigated-tip ablation catheter was placed at the identified rotor core and EGMs were analysed for amplitude, characteristics (single-EGM, fractionated-EGM, and continuous-EGM), and cycle length over 10 s. A total of 72 rotors were identified [right atrium (RA) = 13, left atrium (LA) = 59]. Seven rotors were excluded from EGM analysis due to location in the pulmonary veins. Single-EGMs were more frequent in the RA compared with the LA (8 (61.5) vs. 12 (23.1); P < 0.01) and EGM amplitudes were smaller in LA rotors when compared with RA rotors (0.14 (0.08-0.17) mV vs. 0.19 (0.15-0.29) mV; P = 0.029). In patients with persistent AF, single-EGMs were observed more often in the right-sided rotors compared with left-sided rotors (4 (57.1) vs. 5 (14.3); P = 0.012), and EGM amplitudes were smaller in patients with persistent AF compared with paroxysmal atrial fibrillation (PAF) patients (0.15 (0.09-0.19) mV vs. 0.22 (0.17-0.47) mV; P = 0.03). Furthermore, the prevalence of fractionated- EGMs was higher in patients with persistent AF compared with PAF patients (31/42 (73.8) vs. 9/23 (39.1); P = 0.03).
There are no characteristic rotor-EGM potentials. Rotor-EGM characteristics are different between the RA and LA. Although rotors are not associated with abnormal EGMs, rotor-EGMs in persistent AF were more fractionated with lower amplitudes compared with that in PAF.
在心房颤动（房颤）中，已经进行了碎裂电图（EGM）的消融，以消除缓慢传导区域。转子假说表明，快速激活的螺旋波会持续存在并维持房颤。本研究使用新型的 64 电极篮状导管描述房颤转子的 EGM 特征。
25 名患者（男性 n = 16）患有房颤（阵发性 n = 10），进行了局灶性冲动和转子调制。将 3.5mm 灌流尖端消融导管置于确定的转子核心部位，并对 EGM 进行振幅、特征（单 EGM、碎裂 EGM 和连续 EGM）和 10 秒内的周期长度分析。共确定了 72 个转子[右心房（RA）= 13，左心房（LA）= 59]。由于位于肺静脉内，有 7 个转子被排除在 EGM 分析之外。与 LA 相比，RA 中的单 EGM 更为常见（8（61.5）比 12（23.1）；P < 0.01），并且 LA 转子的 EGM 幅度比 RA 转子小（0.14（0.08-0.17）mV 比 0.19（0.15-0.29）mV；P = 0.029）。在持续性房颤患者中，与左侧转子相比，右侧转子更常观察到单 EGM（4（57.1）比 5（14.3）；P = 0.012），并且持续性房颤患者的 EGM 幅度比阵发性房颤患者小（0.15（0.09-0.19）mV 比 0.22（0.17-0.47）mV；P = 0.03）。此外，与阵发性房颤患者相比，持续性房颤患者的碎裂 EGM 更为常见（31/42（73.8）比 9/23（39.1）；P = 0.03）。
没有特征性的转子 EGM 电位。RA 和 LA 之间的转子 EGM 特征不同。尽管转子与异常 EGM 无关，但与阵发性房颤相比，持续性房颤中的转子 EGM 更具碎裂性，幅度更低。
