Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Am Coll Cardiol. 2017 Mar 14;69(10):1247-1256. doi: 10.1016/j.jacc.2016.11.079.
Mounting evidence shows that localized sources maintain atrial fibrillation (AF). However, it is unclear in unselected "real-world" patients if sources drive persistent atrial fibrillation (PeAF), long-standing persistent atrial fibrillation (LPeAF), or paroxysmal atrial fibrillation (PAF); if right atrial sites are important; and what the long-term success of source ablation is.
The aim of this study was to analyze the role of rotors and focal sources in a large academic registry of consecutive patients undergoing source mapping for AF.
One hundred seventy consecutive patients (mean age 59 ± 12 years, 79% men) with PAF (37%), PeAF (31%), or LPeAF (32%). Of these, 73 (43%) had undergone at least 1 prior ablation attempt (mean 1.9 ± 0.8; range: 1 to 4). Focal impulse and rotor modulation (FIRM) with an endocardial basket catheter was used in all cases.
FIRM analysis revealed sources in the right atrium in 85% of patients (1.8 ± 1.3) and in the left atrium in 90% of patients (2.0 ± 1.3). FIRM ablation terminated AF to sinus rhythm or atrial flutter or tachycardia in 59% (PAF), 37% (PeAF), and 19% (LPeAF) of patients, with 15 of 67 terminations due to right atrial ablation. On follow-up, freedom from AF after a single FIRM procedure for the entire series was 95% (PAF), 83% (PeAF), and 82% (LPeAF) at 1 year and freedom from all atrial arrhythmias was 77% (PAF), 75% (PeAF), and 57% (LPeAF).
In the Indiana University FIRM registry, FIRM-guided ablation produced high single-procedure success, mostly in patients with nonparoxysmal AF. Data from mapping, acute terminations, and outcomes strongly support the mechanistic role of biatrial rotors and focal sources in maintaining AF in diverse populations. Randomized trials of FIRM-guided ablation and mechanistic studies to determine how rotors form, progress, and regress are needed.
越来越多的证据表明局部起源维持着心房颤动（房颤）。然而，在未经选择的“真实世界”患者中，尚不清楚起源是否驱动持续性房颤（PeAF）、长期持续性房颤（LPeAF）或阵发性房颤（PAF）；右房部位是否重要；以及源消融的长期成功率如何。
本研究旨在分析旋转子和灶性起源在接受房颤源标测的连续患者大型学术登记中的作用。
连续 170 例患者（平均年龄 59±12 岁，79%为男性），其中阵发性房颤（PAF）占 37%，持续性房颤（PeAF）占 31%，长期持续性房颤（LPeAF）占 32%。其中 73 例（43%）至少有 1 次消融尝试（平均 1.9±0.8；范围：1 至 4）。在所有病例中均使用心内膜篮状导管进行局灶冲动和旋转调制（FIRM）分析。
FIRM 分析显示 85%的患者（1.8±1.3）右房有起源，90%的患者（2.0±1.3）左房有起源。FIRM 消融使 59%（PAF）、37%（PeAF）和 19%（LPeAF）的患者转为窦性节律或房性扑动或心动过速，其中 67 例终止中有 15 例是由于右房消融。在随访中，整个系列单次 FIRM 手术后无房颤的成功率为 95%（PAF）、83%（PeAF）和 82%（LPeAF），1 年后无所有房性心律失常的成功率为 77%（PAF）、75%（PeAF）和 57%（LPeAF）。
在印第安纳大学 FIRM 登记中，FIRM 指导的消融产生了高的单次手术成功率，主要在非阵发性房颤患者中。来自标测、急性终止和结局的数据强烈支持双房旋转子和灶性起源在不同人群中维持房颤的机制作用。需要进行 FIRM 指导消融的随机试验和机制研究，以确定旋转子如何形成、进展和消退。
