Boles Usama, Gul Enes Elvin, Enriquez Andres, Starr Neasa, Haseeb Sohaib, Abdollah Hoshiar, Simpson Christopher, Baranchuk Adrian, Redfearn Damian, Michael Kevin, Hopman Wilma, Glover Benedict
Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
Heart and Vascular centre, Cardiology department, Mater Private Hospital, Dublin, Ireland.
J Atr Fibrillation. 2018 Jun 30;11(1):1809. doi: 10.4022/jafib.1809. eCollection 2018 Jun-Jul.
Complex fractionated electrograms (EGMs) of the coronary sinus electrograms (CSEs) are employed as a target during radiofrequency ablations (RFA) of atrial fibrillation (AF). Anatomically, CSEs includes both of left atrium (LA), coronary sinus musculature and right atrium (RA) electrograms.
To determine the significance of fractionated CSE and delayed potentials as a predictor of new-onset AF after radiofrequency ablation (RFA) of isolated atrial flutter (AFL).
Consecutive patients underwent AFL ablation. Fractionated and/or continuous discrete activities were recorded from coronary sinus electrograms during sinus rhythm and during pacing. Earliest CSE to the S nadir or peak R in milliseconds was recorded and considered as propagation delay for EGMs.
Forty patients were included during a mean follow-up period of 55.1± 15.8 months. Twenty patients (50 %) developed AF while the remaining 20 patients maintained sinus rhythm(SR) during the follow-up period. Proximal and mid CSEs were significantly fractionated in AF group compared to group with no AF development (65 % and 60% Vs. 35 % and 30 %, p = 0.03, respectively). However, during pacing from distal duo-decapolar catheter (pole 1-2), distal CSEs alone were significantly fractionated (p < 0.05) compared to SR group. Significant delayed propagation of proximal CSE during pacing and in sinus rhythm were observed in AF group (12.3 ± 9.2 ms vs 7.1 ± 3.6 ms, p = 0.03) and (7.2 ± 2.9 ms Vs 8.1 ± 4.6 ms, p= 0.02) in the same order.
Incidence of AF is associated with fractionated proximal and mid CSE in sinus rhythm and distal CSE during paced rhythm after isolated AFL ablation. Delayed proximal CSE propagation is correlated with AF incidence.
在心房颤动（AF）的射频消融（RFA）过程中，冠状窦电图（CSE）的复杂碎裂电图（EGM）被用作靶点。从解剖学角度来看，CSE包括左心房（LA）、冠状窦肌组织和右心房（RA）的电图。
确定碎裂CSE和延迟电位作为孤立性房扑（AFL）射频消融（RFA）后新发AF预测指标的意义。
连续纳入接受AFL消融的患者。在窦性心律和起搏期间，从冠状窦电图记录碎裂和/或连续离散活动。记录从最早的CSE到S波最低点或R波峰值的毫秒数，并将其视为EGM的传导延迟。
40例患者纳入研究，平均随访期为55.1±15.8个月。20例患者（50%）发生AF，其余20例患者在随访期间维持窦性心律（SR）。与未发生AF的组相比，AF组近端和中部CSE的碎裂程度明显更高（分别为65%和60%对35%和30%，p = 0.03）。然而，在从远端双极十极导管（电极1 - 2）起搏时，与SR组相比，仅远端CSE的碎裂程度明显更高（p < 0.05）。在AF组中，观察到起搏期间和窦性心律时近端CSE的传导明显延迟（分别为12.3±9.2毫秒对7.1±3.6毫秒，p = 0.03）以及（7.2±2.9毫秒对8.1±4.6毫秒，p = 0.02）。
孤立性AFL消融后，AF的发生率与窦性心律时近端和中部CSE的碎裂以及起搏心律时远端CSE的碎裂有关。近端CSE传导延迟与AF发生率相关。
