Srivatsa Uma, Cvt Mary Chavez, Krishnamurthy Sankar, Zhongmin L I, Qiu Hong, Chiamvimonvat Nipavan
Division of Cardiovascular Medicine, University of California Davis.
Lovely Professional University, Punjab, India.
J Atr Fibrillation. 2011 Dec 20;4(4):406. doi: 10.4022/jafib.406. eCollection 2011 Dec.
Inflammatory markers (IM) are elevated in atrial fibrillation (AF). However the relation of IM to substrate modificationinAF remains unclear.We sought to assess the relationship of IM to fractio ated atrial electrogram (FAE) in patients undergoing AF ablation.
At baseline, left atrial (LA) pressure was recorded and peripheral blood was tested for IM. FAE mapping wasperformed before and after circumferential pulmonary vein and linear ablation (CPVA-L) and followed by FAEablation. Image processing was used to define the FAE areas. AF cycle-length (AFCL) was compared between baseline and after ablations from left atrial electrode.
Older patients had higher cytokine levels. FAE area at baseline (secondary FAE) negatively correlated with the levels of interleukin-6 (IL-6, R2= -0.97 and p=0.03) and interleukin-12p70 (IL-12p70, R2= -0.97 and p=0.03). In addition, a significant reduction in FAE area and index occurred after CPVA-L (p=0.0001). FAE after CPVA-L (primary FAE) correlated with left atrial pressure (LAP), [R2 0.5, (p=0.02)]. The AFCL (in msec) increased from 135 ± 41 to 149.5+30 (p=ns) after CPVA-L and further increased to 191.5 ± 60 (p=0.007) after FAE ablation.
There is a negative correlation of IL-6 and IL-12p70 to baseline FAE, suggesting a possibility of sequestration of these cytokines in left atrium. CPVA-L ablation reduces FAE area which when ablated increases AFCL, suggesting that these areas likely represent primary fragmentation due to rotors, triggered by atrial stretch as seen by the relation of left atrial pressure and post CPVA-L FAE.
炎症标志物（IM）在心房颤动（AF）中升高。然而，IM与AF中基质改变的关系仍不清楚。我们试图评估在接受AF消融的患者中IM与碎裂心房电图（FAE）的关系。
在基线时，记录左心房（LA）压力并检测外周血中的IM。在环肺静脉和线性消融（CPVA-L）前后进行FAE标测，然后进行FAE消融。使用图像处理来定义FAE区域。比较基线时和左心房电极消融后的AF周期长度（AFCL）。
老年患者的细胞因子水平较高。基线时的FAE面积（继发性FAE）与白细胞介素-6（IL-6，R2 = -0.97，p = 0.03）和白细胞介素-12p70（IL-12p70，R2 = -0.97，p = 0.03）水平呈负相关。此外，CPVA-L后FAE面积和指数显著降低（p = 0.0001）。CPVA-L后的FAE（原发性FAE）与左心房压力（LAP）相关，[R2 0.5，（p = 0.02）]。CPVA-L后AFCL（以毫秒为单位）从135±41增加到149.5 + 30（p =无显著性差异）；FAE消融后进一步增加到191.5±60（p = 0.007）。
IL-6和IL-12p70与基线FAE呈负相关，提示这些细胞因子可能在左心房中被隔离。CPVA-L消融减少了FAE面积，消融后AFCL增加，提示这些区域可能代表由转子引起的原发性碎裂，如左心房压力与CPVA-L后FAE的关系所示，是由心房牵张触发的。
