Rubenstein Donald S, Yin Hang, Azami Sana A
Greenville Health System, Greenville Health System, 701 Grove Road, Greenville, SC 29605.
Provident Sacred Heart Medical Center, 101 W 8th Ave, Spokane, WA 99204.
J Atr Fibrillation. 2018 Aug 31;11(2):2053. doi: 10.4022/jafib.2053. eCollection 2018 Aug.
Rotational circuits that occur between bipolar electrodes exhibit double potentials (DPs). It had been previously surmised that rotors could not be electrically tracked directly.
Our purpose was twofold; first, to show that the use of compass mapping, one can regionally identify rotational activity; and second, to show that by combining simultaneous compass map recordings, standard narrow-adjacent bipolar, and unipolar recordings, that specific signature recording patterns emerge that allow one to identify the accurate time, location, and path of a rotational mechanism.
This was an observational study in 20 patients with persistent atrial fibrillation in which the electrode configuration of a circular mapping catheter was changed to wide cross-circle electrode pairing (compass mapping). DPs were recorded and analyzed from 12 left atrial (LA) sites and identified electrical wavefront patterns and direction. A substudy analyzed transitions patterns with simultaneous narrow-adjacent bipolar and unipolar recordings.
Four wavefront patterns were identified: DPs, peripheral waves (PWs), distal peripheral waves and fibrillatory activity. DP wavefront patterns exhibited significantly shorter cycle lengths than PWs in 8 of 12 LA sites. Patients had 2.9± 2.1 regions that exhibited DPs. DPs of varying duration were found, few (25%) were of stable duration and location. Detailed electrical examination at the transition between a PW to a DP identified a highly consistent pattern of simultaneous reversal of activation sequence, a special form of Doppler effect for spiral waves as a rotor passes between 2 electrodes, and a ½ cycle drop-off of activation signals along the line of electrodes.
DP recordings in compass mode can provide a regional assessment for the existence of rotational activity. Simultaneous DP recordings in compass mode, narrow-adjacent bipolar, and unipolar recording provide an accurate assessment of the time, location, and path that a rotational mechanism breaches a perimeter of electrodes. Accurate time, location and path of perimeter breaches can be used to electrically track rotational mechanisms during atrial fibrillation.
双极电极之间出现的旋转环路表现出双电位（DPs）。此前曾推测转子无法直接进行电追踪。
我们有两个目的；首先，证明使用罗盘标测可以在局部识别旋转活动；其次，证明通过同时记录罗盘标测图、标准窄邻双极和单极记录，会出现特定的特征记录模式，从而能够识别旋转机制的准确时间、位置和路径。
这是一项对20例持续性心房颤动患者的观察性研究，其中将环形标测导管的电极配置改为宽跨环电极配对（罗盘标测）。从12个左心房（LA）部位记录并分析DPs，确定电波前模式和方向。一项子研究分析了同时进行窄邻双极和单极记录时的转换模式。
识别出四种波前模式：DPs、外周波（PWs）、远端外周波和颤动活动。在12个LA部位中的8个部位，DP波前模式的周期长度明显短于PWs。患者有2.9±2.1个表现出DPs的区域。发现了不同持续时间的DPs，很少（25%）具有稳定的持续时间和位置。在PW向DP转换时进行的详细电检查发现，激活序列同时反转的模式高度一致，这是螺旋波作为转子在两个电极之间通过时的一种特殊形式的多普勒效应，以及沿电极线激活信号下降半个周期。
罗盘模式下的DP记录可为旋转活动的存在提供局部评估。罗盘模式下的同时DP记录、窄邻双极和单极记录可准确评估旋转机制突破电极周边的时间、位置和路径。周长突破的准确时间、位置和路径可用于在心房颤动期间对旋转机制进行电追踪。
