Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy.
Applied Research, Abbott, Sylmar, CA, USA.
Europace. 2019 Aug 1;21(8):1193-1202. doi: 10.1093/europace/euz123.
Clinical outcomes after radiofrequency catheter ablation (RFCA) remain suboptimal in the treatment of non-paroxysmal atrial fibrillation (AF). Electrophysiological mapping may improve understanding of the underlying mechanisms. To describe the arrhythmia substrate in patients with persistent (Pers) and long-standing persistent (LSPers) AF, undergoing RFCA, using an integrated mechanism mapping technique.
Patients underwent high-density electroanatomical mapping before and after catheter ablation. Integrated maps characterized electrogram (EGM) cycle length (CL) in regions with repetitive-regular (RR) activations, stable wavefront propagation, fragmentation, and peak-to-peak bipolar voltage. Among 83 patients (72% male, 60 ± 11 years old), RR activations were identified in 376 regions (mean CL 180 ± 31 ms). PersAF patients (n = 43) showed more RR sites per patient (5.3 ± 2.4 vs. 3.7 ± 2.1, P = 0.002) with faster CL (166 ± 29 vs. 190 ± 29 ms; P < 0.001) and smaller surface area of fragmented EGMs (15 ± 14% vs. 27 ± 17%, P < 0.001) compared with LSPersAF. The post-ablation map in 50 patients remaining in AF, documented reduction of the RR activities per patient (1.5 ± 0.7 vs. 3.7 ± 1.4, P < 0.001) and area of fragmentation (22 ± 17% vs. 8 ± 9%, P < 0.001). Atrial fibrillation termination during ablation occurred at RR sites (0.48 ± 0.24 mV; 170.5 ± 20.2 ms CL) in 31/33 patients (94%). At the latest follow-up, arrhythmia freedom was higher among patients receiving ablation >75% of RR sites (Q4 82.6%, Q3 63.1%, Q2 35.1%, and Q1 0%; P < 0.001).
The integrated mapping technique allowed characterization of multiple arrhythmic substrates in non-paroxysmal AF patients. This technique might serve as tool for a substrate-targeted ablation approach.
射频导管消融（RFCA）治疗非阵发性心房颤动（AF）的临床疗效仍不理想。电生理标测可能有助于了解潜在的机制。本研究旨在采用整合机制标测技术，描述持续性（Pers）和长程持续性（LSPers）AF 患者 RFCA 前后的心律失常基质。
患者在导管消融前后进行高密度电生理标测。整合图谱以特征性的电描记图（EGM）周期长度（CL）来描述具有重复规则（RR）激活、稳定波阵面传播、碎裂和峰-峰双极电压的区域。在 83 例患者（72%为男性，60±11 岁）中，RR 激活在 376 个区域中被识别（平均 CL 为 180±31ms）。PersAF 患者（n=43）的 RR 部位更多（5.3±2.4 比 3.7±2.1，P=0.002），CL 更快（166±29 比 190±29ms，P<0.001），碎裂 EGM 面积更小（15±14%比 27±17%，P<0.001）。50 例仍处于 AF 状态的患者在消融后的标测图中，RR 活动的数量减少（1.5±0.7 比 3.7±1.4，P<0.001），碎裂面积减少（22±17%比 8±9%，P<0.001）。在 33 例（94%）患者中，消融时 AF 终止于 RR 部位（0.48±0.24mV；170.5±20.2ms CL）。在最新的随访中，RR 部位消融>75%的患者心律失常无复发率更高（Q4 82.6%、Q3 63.1%、Q2 35.1%和 Q1 0%；P<0.001）。
整合图谱技术可对非阵发性 AF 患者的多种心律失常基质进行特征描述。该技术可能成为一种针对基质的消融方法。
