Vraka Aikaterini, Bertomeu-González Vicente, Fácila Lorenzo, Moreno-Arribas José, Alcaraz Raúl, Rieta José J
BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain.
Cardiology Department, Saint John's University Hospital, 03550 Alicante, Spain.
J Pers Med. 2022 Mar 14;12(3):462. doi: 10.3390/jpm12030462.
Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (p≤0.0014) and distal/mid-proximal channels (p≤0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (≥93%) than distal (≤91%) areas. P-waves: duration was significantly shortened after LPVI (after L: p=0.0012, −13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, p≤0.0480, R: <−33.94%, p≤0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.
自从发现肺静脉（PVs）是最常见的心律失常——心房颤动（AF）的病灶以来，研究主要围绕肺静脉导管消融（CA）的结果展开。尽管如此，CA过程本身却相当被忽视。我们旨在分别剖析CA的关键步骤：冠状窦（CS）插管以及左、右肺静脉隔离（LPVI、RPVI）的影响。我们招募了40例首次接受CA的阵发性AF患者，并在CA前（B）、LPVI后（L）和RPVI后（R）的窦性心律（SR）期间获取了5分钟的II导联和双极CS记录。除其他外，计算了P波和CS局部激活波（LAWs）的持续时间、幅度和心房率变异性（ARV）。比较了CS通道之间的LAWs特征以进行可靠性分析。在每个消融步骤（B、L、R）后比较了P波和LAWs特征。CS通道：远端/内侧（p≤0.0014）和远端/中近端通道之间的幅度和面积不同（p≤0.0025）。内侧和远端分别显示出最和最不相关的值。近端区域（≥93%）的相关性高于远端区域（≤91%）。P波：LPVI后持续时间显著缩短（L后：p = 0.0012，-13.30%）。LAWs：变化不显著。ARV改变在LAWs中更为突出（L：>+73.12%，p≤0.0480，R：<-33.94%，p≤0.0642）。建议在SR期间使用内侧/中近端通道。CS LAWs不受CA的显著影响，但它们更精确地描述了CA引起的ARV改变。LPVI对阵发性AF CA的影响最大，显著改变了P波持续时间。
