心电图空间环路显示在消融相关转变为房性心动过速前数分钟房颤的组织情况。
Electrocardiographic spatial loops indicate organization of atrial fibrillation minutes before ablation-related transitions to atrial tachycardia.
作者信息
Baykaner Tina, Trikha Rishi, Zaman Junaid A B, Krummen David E, Wang Paul J, Narayan Sanjiv M
机构信息
Stanford University, CA, USA.
Cedars Sinai Medical Center, CA, USA.
出版信息
J Electrocardiol. 2017 May-Jun;50(3):307-315. doi: 10.1016/j.jelectrocard.2017.01.007. Epub 2017 Jan 15.
BACKGROUND
During ablation for atrial fibrillation (AF), it is challenging to anticipate transitions to organized tachycardia (AT). Defining indices of this transition may help to understand fibrillatory conduction and help track therapy.
OBJECTIVE
To determine the timescale over which atrial fibrillation (AF) organizes en route to atrial tachycardia (AT) using the ECG referenced to intracardiac electrograms.
METHODS
In 17 AF patients at ablation (58.7±9.6years; 53% persistent AF) we analyzed spatial loops of atrial activity on the ECG and intracardiac electrograms over successive timepoints. Loops were tracked at precisely 15, 10, 5, 3 and 1min prior to defined transitions of AF to AT.
RESULTS
Organizational indices reliably quantified changes from AF to AT. Spatiotemporal AF organization on the ECG was identifiable at least 15min before AT was established (p=0.02).
CONCLUSIONS
AF shows anticipatory global organization on the ECG minutes before AT is clinically evident. These results offer a foundation to establish when AF therapy is on an effective path, and for a quantitative classification separating AT from AF.
背景
在心房颤动（AF）消融过程中，预测向有组织性心动过速（AT）的转变具有挑战性。定义这种转变的指标可能有助于理解颤动传导并有助于跟踪治疗。
目的
使用参考心内电图的心电图确定心房颤动（AF）转变为心房性心动过速（AT）的时间尺度。
方法
在17例接受消融治疗的AF患者中（年龄58.7±9.6岁；53%为持续性AF），我们分析了连续时间点上心电图表和心内电图上心房活动的空间环。在定义的AF转变为AT之前的15、10、5、3和1分钟精确跟踪这些环。
结果
组织学指标可靠地量化了从AF到AT的变化。在AT确立前至少15分钟，心电图上的时空AF组织是可识别的（p=0.02）。
结论
在临床上AT明显出现前几分钟，AF在心电图上显示出预期的整体组织。这些结果为确定AF治疗何时走上有效路径以及将AT与AF进行定量分类提供了基础。
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