Ammar-Busch Sonia, Reents Tilko, Knecht Sebastien, Rostock Thomas, Arentz Thomas, Duytschaever Mattias, Neumann Thomas, Cauchemez Bruno, Albenque Jean-Paul, Hessling Gabriele, Deisenhofer Isabel
Klinikum Coburg, Coburg, Germany.
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet, Munich, Germany.
Pacing Clin Electrophysiol. 2018 Oct;41(10):1279-1285. doi: 10.1111/pace.13483. Epub 2018 Sep 12.
The aim of this study was to evaluate a spatial correlation between active atrial fibrillation (AF) drivers measured by electrocardiographic imaging and complex fractionated atrial electrograms (CFAEs) in patients with persistent AF.
Sixteen patients with persistent AF were included. A biatrial geometry relative to an array of 252-body-surface-electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms were signal-processed (ECVUE™, CardioInsight Technologies Inc., Cleveland, OH, USA) to identify AF drivers. Before driver ablation, a biatrial mapping using the NavX system (St. Jude Medical, St. Paul, MN, USA) was performed to identify CFAEs. CFAE and driver regions were then quantified and compared.
AF was terminated by driver ablation in 11/16 (70%) patients. The mean number of ablated driver regions was 4 ± 1 per patient. The most frequent driver locations were the inferior left atrium and coronary sinus, the right pulmonary veins, and the right atrium. In 49/63 (78%) of the driver locations, more than 75% of the driver site showed CFAEs. The mean ablated driver area was 58 ± 24 cm (19 ± 11% of total surface area). The mean CFAE area was 178 ± 59 cm (49 ± 16%). The percentage of non-ablated CFAE area was 76 ± 13% of total CFAEs. In 9/11 patients with AF termination, the termination site showed CFAEs.
There is a significant overlap between AF driver regions identified by the ECVUE™ system and CFAE areas identified by the NavX system. AF driver regions are smaller and mostly embedded in larger CFAE areas. Selective ablation of drivers in CFAE areas seems sufficient to terminate persistent AF in the majority of patients.
本研究的目的是评估持续性房颤患者中通过心电图成像测量的活动性房颤驱动因素与复杂碎裂心房电图（CFAE）之间的空间相关性。
纳入16例持续性房颤患者。通过非增强计算机断层扫描获得相对于252体表电极阵列的双心房几何形状。对重建的单极房颤电图进行信号处理（ECVUE™，美国俄亥俄州克利夫兰市CardioInsight Technologies公司）以识别房颤驱动因素。在驱动因素消融前，使用NavX系统（美国明尼苏达州圣保罗市圣犹达医疗公司）进行双心房标测以识别CFAE。然后对CFAE和驱动因素区域进行量化并比较。
11/16（70%）例患者的房颤通过驱动因素消融得以终止。每位患者消融的驱动因素区域平均数为4±1个。最常见的驱动因素位置是左心房下部和冠状窦、右肺静脉以及右心房。在49/63（78%）的驱动因素位置中，超过75%的驱动因素部位显示有CFAE。消融的驱动因素平均面积为58±24平方厘米（占总面积的19±11%）。CFAE平均面积为178±59平方厘米（49±16%）。未消融的CFAE面积占总CFAE面积的76±13%。在9/11例房颤终止的患者中，终止部位显示有CFAE。
ECVUE™系统识别的房颤驱动因素区域与NavX系统识别的CFAE区域之间存在显著重叠。房颤驱动因素区域较小，且大多嵌入较大的CFAE区域。在CFAE区域选择性消融驱动因素似乎足以使大多数患者的持续性房颤终止。
