Sasaki Naoko, Watanabe Ichiro, Okumura Yasuo, Nagashima Koichi, Kogawa Rikitake, Sonoda Kazumasa, Iso Kazuki, Takahashi Keiko, Arai Masaru, Watanabe Ryuta, Kurokawa Sayaka, Ohkubo Kimie, Nakai Toshiko, Hirayama Atsushi, Nikaido Mizuki
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Oyaguchi-Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
Nihon Kohden Corporation, 1-11-15 Higashigotanda, Shinagawa-ku, Tokyo 141-0022, Japan.
J Arrhythm. 2017 Jun;33(3):185-191. doi: 10.1016/j.joa.2016.10.001. Epub 2016 Oct 27.
Ablation targeting complex fractionated atrial electrograms (CFAEs) or high dominant frequency (DF) sites is generally effective for persistent atrial fibrillation (AF). CFAEs and/or high DF sites may exist in low-voltage regions, which theoretically represent abnormal substrates. However, whether CFAEs or high DF sites reflect low voltage substrates during sinus rhythm (SR) is unknown.
Sixteen patients with AF (8 with paroxysmal AF; 8, persistent AF) underwent high-density mapping of the left atrium (LA) with a 3-dimensional electroanatomic mapping system before ablation. The LA was divided into 7 segments and the mean bipolar voltage recorded during AF and SR, CFAEs (cycle lengths of 50-120 ms), and DF sites were assessed in each segment with either a duo-decapolar ring catheter (n=10) or a 64-pole basket catheter (n=6). Low-voltage areas were defined as those of <0.5 mV during AF and <1.0 mV during SR.
Regional mean voltage recorded from the basket catheter showed good correlation between AF and SR (r=0.60, <0.01); however, the % low-voltage area in the LA recorded from the ring catheter showed weak correlation (r=0.34, =0.05). Mean voltage was lower during AF than during SR (1.0 mV [IQR, 0.5-1.4] vs. 2.6 mV [IQR, 1.8-3.6], <0.01). The regional and overall % low-voltage area of the LA was greater during AF than during SR (20% vs. 11%, =0.05). CFAEs and high DF sites (>8 Hz) did not correlate with % low-voltage sites during SR; however, CFAEs sites were located in high-voltage regions during AF and high DF sites were located in low voltage regions during AF.
CFAEs and high DF areas during AF do not reflect damaged atrial myocardium as shown by the SR voltage. However, CFAEs and high DF sites may demonstrate different electrophysiologic properties because of different voltage amplitude during AF.
针对复杂碎裂心房电图（CFAEs）或高主导频率（DF）部位的消融通常对持续性心房颤动（AF）有效。CFAEs和/或高DF部位可能存在于低电压区域，理论上这些区域代表异常基质。然而，在窦性心律（SR）期间，CFAEs或高DF部位是否反映低电压基质尚不清楚。
16例AF患者（8例阵发性AF；8例持续性AF）在消融前用三维电解剖标测系统对左心房（LA）进行高密度标测。将LA分为7个节段，使用双极十极环导管（n = 10）或64极篮状导管（n = 6）评估每个节段在AF和SR期间记录的平均双极电压、CFAEs（周期长度为50 - 120 ms）和DF部位。低电压区域定义为AF期间<0.5 mV且SR期间<1.0 mV的区域。
篮状导管记录的区域平均电压显示AF和SR之间具有良好的相关性（r = 0.60，<0.01）；然而，环导管记录的LA中低电压区域百分比显示相关性较弱（r = 0.34，=0.05）。AF期间的平均电压低于SR期间（1.0 mV [四分位间距，0.5 - 1.4] 对比 2.6 mV [四分位间距，1.8 - 3.6]，<0.01）。LA的区域和总体低电压区域百分比在AF期间大于SR期间（20% 对比 11%，=0.05）。SR期间，CFAEs和高DF部位（>8 Hz）与低电压部位百分比无相关性；然而，AF期间CFAEs部位位于高电压区域，高DF部位位于低电压区域。
AF期间的CFAEs和高DF区域并不像SR电压所显示的那样反映受损的心房心肌。然而，由于AF期间电压幅度不同，CFAEs和高DF部位可能表现出不同的电生理特性。
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