Liu Zheng, Xia Yu, Guo Changyan, Li Xiaofeng, Fang Pihua, Yin Xiandong, Yang Xinchun
Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Aug 2;8:705510. doi: 10.3389/fcvm.2021.705510. eCollection 2021.
Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships. A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area. The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF. The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.
低电压区（LVZs）通常是心房颤动（AF）消融的靶点。然而，其与房颤起始、持续和终止的关系仍有待研究。本研究旨在探讨此类关系。共纳入126例连续的房颤患者，其中71例患者进行房颤诱发方案，55例患者进行房颤终止方案。可诱导性和持续性房颤分别定义为诱发的房颤持续超过30秒和300秒。可终止性房颤定义为在给予伊布利特后1小时内可转为窦性心律的房颤。对所有患者在窦性心律下进行电压标测。LVZ量化为LVZ面积（LVZ%）占左心房表面积的百分比。可诱导性、持续性和可终止性房颤的发生率分别为29.6%、18.3%和38.2%。可诱导性房颤患者与不可诱导性房颤患者相比，总体LVZ%无显著差异（10.2±11.8 vs. 8.5±12.6，P = 0.606），而持续性和不可终止性房颤患者的总体LVZ%分别比不可持续性（16.2±11.5 vs. 0.5±0.7，P < 0.001）和可终止性房颤患者（44.6±26.4 vs. 26.3±22.3，P < 0.05）更大。在房颤的不同阶段，节段性LVZ分布模式各不相同。在可诱导性房颤患者中，最初在前壁观察到节段性LVZ%差异，在持续性房颤患者中，间隔进一步受到影响，在不可终止性房颤患者中，最后房顶、后壁和心底受到影响。LVZ与房颤起始、持续和终止之间的关联因其大小和分布而异。
