Department of Medicine, Case Western Reserve University, Cleveland, OH.
Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
J Am Heart Assoc. 2017 Mar 17;6(3):e005274. doi: 10.1161/JAHA.116.005274.
We previously demonstrated that persistent and long-standing persistent atrial fibrillation is maintained by activation emanating from foci and breakthrough sites of different cycle lengths (CLs). The purpose of this study was to characterize the behavior of focal and nonrandom breakthrough activation identified during high-density mapping of atrial fibrillation in these patients.
During open heart surgery, we recorded activation from both atria simultaneously using 510 to 512 epicardial electrodes along with ECG lead II in 12 patients with persistent and long-standing persistent atrial fibrillation. For each patient, analysis of 32 consecutive seconds of activation from identified focal (sustained and/or intermittent) and nonrandom breakthrough sites was performed. Multiple foci (sustained and/or intermittent) of different CLs were present in both atria in 11 of 12 patients; 8 foci were sustained, and 22 were intermittent. Temporal CL behavior of sustained foci varied over time (≤20 ms of the mean CL). For intermittent foci, no activation periods were due to a spontaneous pause (18 of 22) or activation of the focus by another wave front (11 of 22). All patients had breakthrough activation. Seven patients had 12 nonrandom breakthrough sites. Periods of no breakthrough activation were caused by a spontaneous pause (6 of 12 patients) or activation from another wave front (4 of 12) or were uncertain (5 of 12). Focal and nonrandom breakthrough activation sometimes produced repetitive "wannabe" (incomplete) reentry in 6 of 12 patients.
During persistent and long-standing persistent atrial fibrillation, sustained foci manifested variable CLs. Spontaneous pauses or activation from other wave fronts explained the intermittency of foci and nonrandom breakthrough. Focal and nonrandom breakthrough activation occasionally produced wannabe reentry.
我们之前的研究表明，持久和长期持续性心房颤动是由源自不同周长（CL）焦点和突破部位的激活维持的。本研究的目的是描述在这些患者的持续性和长期持续性心房颤动的高密度映射过程中识别的局灶性和非随机突破激活的行为特征。
在心脏直视手术中，我们同时使用 510 到 512 个心外膜电极以及心电图导联 II 在 12 名持续性和长期持续性心房颤动患者的左右心房同时记录激活。对每个患者，对从识别的局灶性（持续和/或间歇性）和非随机突破部位连续 32 秒的激活进行分析。在 12 名患者中的 11 名患者中，左右心房均存在多个不同 CL 的焦点（持续和/或间歇性）；8 个焦点是持续的，22 个是间歇性的。持续焦点的 CL 行为随时间变化（与平均 CL 的偏差≤20ms）。对于间歇性焦点，由于自发暂停（18/22）或另一个波前激活焦点（11/22），没有激活期。所有患者均有突破激活。7 名患者有 12 个非随机突破部位。无突破激活期是由自发暂停（12 名患者中的 6 名）或来自另一个波前的激活（12 名患者中的 4 名）或不确定（12 名患者中的 5 名）引起的。在 12 名患者中的 6 名患者中，局灶性和非随机突破激活有时会产生重复的“ wannabe”（不完全）折返。
在持续性和长期持续性心房颤动中，持续的焦点表现出可变的 CL。自发暂停或来自其他波前的激活解释了焦点和非随机突破的间歇性。局灶性和非随机突破激活偶尔会产生 wannabe 折返。
