在持续性心房颤动患者中，基于心电图成像评估的折返活性与心脏磁共振延迟钆增强检测到的纤维化之间的关系。
Relationship Between Fibrosis Detected on Late Gadolinium-Enhanced Cardiac Magnetic Resonance and Re-Entrant Activity Assessed With Electrocardiographic Imaging in Human Persistent Atrial Fibrillation.
机构信息
Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France.
National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France.
出版信息
JACC Clin Electrophysiol. 2018 Jan;4(1):17-29. doi: 10.1016/j.jacep.2017.07.019. Epub 2017 Nov 6.
OBJECTIVES
This study sought to assess the relationship between fibrosis and re-entrant activity in persistent atrial fibrillation (AF).
BACKGROUND
The mechanisms involved in sustaining re-entrant activity during AF are poorly understood.
METHODS
Forty-one patients with persistent AF (age 56 ± 12 years; 6 women) were evaluated. High-resolution electrocardiographic imaging (ECGI) was performed during AF by using a 252-chest electrode array, and phase mapping was applied to locate re-entrant activity. Sites of high re-entrant activity were defined as re-entrant regions. Late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was performed at 1.25 × 1.25 × 2.5 mm resolution to characterize atrial fibrosis and measure atrial volumes. The relationship between LGE burden and the number of re-entrant regions was analyzed. Local LGE density was computed and characterized at re-entrant sites. All patients underwent catheter ablation targeting re-entrant regions, the procedural endpoint being AF termination. Clinical, CMR, and ECGI predictors of acute procedural success were then analyzed.
RESULTS
Left atrial (LA) LGE burden was 22.1 ± 5.9% of the wall, and LA volume was 74 ± 21 ml/m. The number of re-entrant regions was 4.3 ± 1.7 per patient. LA LGE imaging was significantly associated with the number of re-entrant regions (R = 0.52, p = 0.001), LA volume (R = 0.62, p < 0.0001), and AF duration (R = 0.54, p = 0.0007). Regional analysis demonstrated a clustering of re-entrant activity at LGE borders. Areas with high re-entrant activity showed higher local LGE density as compared with the remaining atrial areas (p < 0.0001). Failure to achieve AF termination during ablation was associated with higher LA LGE burden (p < 0.001), higher number of re-entrant regions (p < 0.001), and longer AF duration (p = 0.008).
CONCLUSIONS
The number of re-entrant regions during AF relates to the extent of LGE on CMR, with the location of these regions clustering to LGE areas. These characteristics affect procedural outcomes of ablation.
目的
本研究旨在评估持续性心房颤动（AF）中纤维化与折返活动之间的关系。
背景
维持 AF 期间折返活动的机制尚不清楚。
方法
评估了 41 例持续性 AF 患者（年龄 56±12 岁；6 名女性）。通过使用 252 个胸电极阵列在 AF 期间进行高分辨率心电图成像（ECGI），并应用相位映射定位折返活动。高折返活动部位定义为折返区。以 1.25×1.25×2.5mm 分辨率进行心脏磁共振（CMR）延迟钆增强（LGE），以特征化心房纤维化并测量心房容积。分析 LGE 负荷与折返区数量之间的关系。计算并描绘折返部位的局部 LGE 密度。所有患者均接受针对折返区的导管消融治疗，终点为 AF 终止。然后分析临床、CMR 和 ECGI 预测急性手术成功的指标。
结果
左心房（LA）LGE 负荷为 22.1±5.9%的壁，LA 容积为 74±21ml/m。每位患者的折返区数量为 4.3±1.7 个。LA LGE 成像与折返区数量（R=0.52，p=0.001）、LA 容积（R=0.62，p<0.0001）和 AF 持续时间（R=0.54，p=0.0007）显著相关。区域分析显示折返活动在 LGE 边界处聚集。高折返活动区域的局部 LGE 密度高于其余心房区域（p<0.0001）。消融过程中不能终止 AF 与较高的 LA LGE 负荷（p<0.001）、较多的折返区数量（p<0.001）和较长的 AF 持续时间（p=0.008）相关。
结论
AF 期间折返区的数量与 CMR 上的 LGE 范围相关，这些区域的位置聚集在 LGE 区域。这些特征影响消融的手术结果。
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