Department of Cardiology, Alfred Hospital, Victoria, Australia; Baker IDI Heart and Diabetes Institute, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
Department of Cardiology, Alfred Hospital, Victoria, Australia.
JACC Clin Electrophysiol. 2018 Jan;4(1):87-96. doi: 10.1016/j.jacep.2017.08.012. Epub 2017 Nov 6.
This study sought to characterize the biatrial substrate in heart failure (HF) and persistent atrial fibrillation (PeAF).
Atrial fibrillation (AF) and HF frequently coexist; however, the contribution of HF to the biatrial substrate in PeAF is unclear.
Consecutive patients with PeAF and normal left ventricular (NLV) systolic function (left ventricular ejection fraction [LVEF] >55%) or idiopathic cardiomyopathy (LVEF ≤45%) undergoing AF ablation were enrolled. In AF, pulmonary vein (PV) cycle length (PVCL) was recorded via a multipolar catheter in each PV and in the left atrial appendage for 100 consecutive cycles. After electrical cardioversion, biatrial electroanatomic mapping was performed. Complex electrograms, voltage, scarring, and conduction velocity were assessed.
Forty patients, 20 patients with HF (mean age: 62 ± 8.9 years; AF duration: 15 ± 11 months; LVEF: 33 ± 8.4%) and 20 with NLV (mean age: 59 ± 6.7 years; AF duration: 14 ± 9.1 months; p = 0.69; mean LVEF: 61 ± 3.6%; p < 0.001), were enrolled. HF reduced biatrial tissue voltage (p < 0.001) with greater voltage heterogeneity (p < 0.001). HF was associated with significantly more biatrial fractionation (left atrium [LA]: 30% vs. 9%; p < 0.001; right atrium [RA]: 28% vs. 11%; p < 0.001), low voltage (<0.5 mV) (LA: 23% vs. 6%; p = 0.002; RA: 20% vs 11%; p = 0.006), and scarring (<0.05 mV) in the LA (p = 0.005). HF was associated with a slower average PVCL (185 vs. 164 ms; p = 0.016), which correlated significantly with PV antral bipolar voltage (R = -0.62; p < 0.001) and fractionation (R = 0.46; p = 0.001).
HF is associated with significantly reduced biatrial tissue voltage, fractionation, and prolongation of PVCL. Advanced biatrial remodeling may have implications for invasive and noninvasive rhythm control strategies in patients with AF and HF.
本研究旨在描述心力衰竭（HF）和持续性心房颤动（PeAF）患者的双心房基质特征。
心房颤动（AF）和 HF 常同时存在；然而，HF 对 PeAF 中的双心房基质的贡献尚不清楚。
连续纳入接受 AF 消融治疗的 PeAF 且左心室射血分数（LVEF）正常（>55%）或特发性扩张型心肌病（LVEF≤45%）的患者。在 AF 中，通过每个肺静脉（PV）和左心耳中的多极导管记录 100 个连续的 PV 周期长度（PVCL）。电复律后，进行双心房电解剖标测。评估复杂的电图、电压、瘢痕和传导速度。
共纳入 40 例患者，其中 20 例 HF 患者（平均年龄：62±8.9 岁；AF 持续时间：15±11 个月；LVEF：33±8.4%）和 20 例 NLV 患者（平均年龄：59±6.7 岁；AF 持续时间：14±9.1 个月；p=0.69；平均 LVEF：61±3.6%；p<0.001）。HF 降低了双心房组织电压（p<0.001），同时电压异质性增加（p<0.001）。HF 与明显更多的双心房分割（LA：30%比 9%；p<0.001；RA：28%比 11%；p<0.001）、低电压（<0.5 mV）（LA：23%比 6%；p=0.002；RA：20%比 11%；p=0.006）和 LA 瘢痕（<0.05 mV）相关（p=0.005）。HF 患者的平均 PVCL 较慢（185 比 164 ms；p=0.016），与 PV 窦部双极电压（R=-0.62；p<0.001）和分割（R=0.46；p=0.001）显著相关。
HF 与双心房组织电压、分割和 PVCL 延长明显相关。高级双心房重构可能对 AF 和 HF 患者的有创和无创节律控制策略有影响。
